Mental Stress

Chronic heart failure in the elderly has a poor prognosis, but is this made worse if one is subjected to chronic stress vs. if they weren’t?

We surely know that chronic stress can contribute to the development of coronary artery disease.

You may also know that coronary artery disease is a risk factor or can lead to chronic heart failure.

However, what about a direct causal relationship between anxiety or stress, and a worsening of a pre-existing longstanding heart failure?

Another intriguing point to consider is the effect of a new-onset, deeper level of chronic stress on chronic heart failure that’s already been in the severe range.

An analogy might be this: How damaging can jumping with a knee – that’s already been mangled through-and-through from a ski accident – actually be?

In other words, the knee is so shredded that it couldn’t get any worse even if the patient began jumping.

What Exactly Is Chronic Heart Failure?

• An ongoing situation in which the heart does not pump enough blood with each beat for optimal oxygenation of the body.

• The heart’s “squeezing” is weak. Each beat ejects an inadequate amount of blood. The lower the left ventricular ejection fraction, the less blood that is pumped out. This is systolic heart failure.

• However, in diastolic heart failure, the pumping action is okay, but the heart does not fill with enough blood to be pumped out. The net result, then, is an insufficient amount of blood being pumped out.

Can a person’s longstanding heart failure be bad enough such that new stress in their life would have no effect, just like jumping on a destroyed knee joint would not make it any worse because it’s so damaged already?

“This is a challenging question to answer with great certainty,” begins George Ruiz, MD, chief of cardiology at MedStar Union Memorial and MedStar Good Samaritan Hospitals, who specializes in the care of adults with advanced heart failure, pulmonary hypertension, congenital heart disease and heart disease during pregnancy.

Dr. Ruiz explains, “I think it’s more helpful to understand how the mind and the heart impact each other.

“Heart failure often impacts a patient’s ability to meet their daily demands – this can lead to escalating mental health issues which we know can adversely impact prognosis.

“Providers of care often overlook mental health issues in CHF patients. Treating these issues can improve patients’ quality of life, which is super important for both patients and their families.

“Regular health maintenance can also have an impact – a focus on diet, sleep habits, avoidance of alcohol and other depressants can also improve patient’s overall well-being.

“Heart failure impacts all aspects of a patient’s life. Therefore, it would not be far-fetched that improving mental health would also improve the body’s resilience and ability to cope with CHF.”

Baseline Mental Stress vs. Worsening Mental Stress

The patient may have always been a worry wart of sorts, rather than the type who has a “mellow as a clam” disposition.

So the variable then becomes a new situation in their life that intensifies their baseline stress and anxiety levels.

There are no conclusive studies that can quantitate a causal relationship between the worsening of chronic heart failure with additional mental stress or anxiety in the person’s life (e.g., losing home to foreclosure; just learned grandchild is dying from cancer; adult child with two preschoolers loses job/evicted from apartment and moves into the patient’s home).

The inconclusive nature is especially true with subsets of longstanding heart failure, such as stage 4 disease, or in patients over 80, or in patients who do very little exercise.

Dr. Ruiz also treats patients with congenital heart disease and heart disease during pregnancy. From 2006 to 2007 he served as a White House Fellow and was a special assistant to the Secretary of Veteran Affairs.