Heart Failure

Managing Stress and Heart Failure

For most people, stress is a fact of life. But what is stress? Hans Selye, a physiologist, described stress as "the nonspecific response of the body to any demand made upon it."

Your body responds to stress by preparing to meet the demand or by taking action. When you experience stress, the adrenal glands release the stress hormones adrenaline and cortisol. The heart speeds up, blood vessels are constricted, and clotting factors in the blood are activated as preparation for a possible injury. This response burdens the heart muscle and reduces the supply of blood to the coronary arteries. This response is often called the "flight or fight response".

In general, these changes last only until the stressful event passes, then your body returns to its normal level of functioning. If the stress is present for any length of time, your body begins adapting to the stress. This adaptation can contribute to other problems such as hypertension, shortness of breath, muscle/joint pain, depression, and fatigue.

Stress and Heart Failure

Stress and heart failure have a circular relationship with each affecting the other. Stress may worsen the symptoms of your heart failure and/or you may feel more stressed because you have been diagnosed with heart failure.

Stress has also been known to intensify the symptoms of your heart failure and may increase the number of episodes that you experience.

Common Types of Stress

Regardless of the type of stress, the changes that occur in your body remain the same. Few people experience only one type of stress or one stressor at a time. In many cases, one type of stress can lead to other stressors or even magnify the effects of existing stressors. For example, individuals who have financial problems find this stress increases when asked to eat a special diet in order to minimize the effects of their heart failure.

Physical stressors: Physical stressors are those that increase your body’s demand for energy. Examples include picking up your grandchild for the first time or grocery shopping. If your body isn't prepared to deal with this demand you may experience increased fatigue, sore muscles, or a worsening of some disease symptoms (e.g. shortness of breath).

Mental and emotional stressors: Mental stressors are those that lead to an emotional reaction. These reactions can range from pleasant to uncomfortable and include seeing a child get married, starting a new job, frustration due to the physical limitations you experience as a result of your illness. Emotional stress and anxiety make the heart work harder, which can make symptoms worse. That is why patients and their caregivers should work together to keep stress under control.

Environmental Stressors: Environmental stressors are those that result from your surroundings and may be as varied as secondhand smoke, uneven sidewalks that make it difficult to walk or loud noise that affects your sleep.

Gaining Control Over Your Stress

Since stress is a part of life, learning skills to manage stress can help you to feel better both physically and emotionally. Many strategies for managing stress are effective, it is important to find several that work for you. Below are steps you can take to gain control over stress.

Identify the sources of your stress and remember it may not be your heart failure.
Divide this list of stressors into things you can and can’t control. Learn to accept things you can't change. You do not have to solve all of life's problems.
If you know that certain situations will be stressful, develop ways to deal with them before they happen. This is known as problem-solving. Focus on strategies that have worked before.
Participate in relaxing and distracting activities on a regular basis (e.g. listening to music, fishing, woodworking, reading). Although some people tend to smoke a cigarette, drink a glass of wine, or drink a cup of coffee to soothe their tension, these actually increase the body's stress response.
Be more assertive, set limits, and say "No". Do not promise too much. Give yourself enough time to get things done.
Try to be more flexible
Get close to somebody
Remember to laugh!
Seek professional help if your efforts are ineffective
Join a support group - maybe for people with heart disease, for women, for men, for retired persons or some other group with which you identify.
Consider a mental health professional or clergy to help you manage stress.

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Last Reviewed: Feb 11, 2009

Ileana L Piña, MD
Professor, VA Quality Scholar
Louis Stokes VA Medical Center
School of Medicine
Case Western Reserve University