Blowing Your Top Is Dangerous to Your Heart

A group of physicians, headed by Dr Rachel Lampert of Yale University, has reported that anger-induced changes in the electrical conduction system in the heart can predict future dangerous heart rhythm irregularities. They published the results of their study in the Journal of the American College of Cardiology this month.

Previous studies have demonstrated increased frequency of sudden cardiac death during times of population stress, e.g. earthquake, or war. The researchers in this study investigated this phenomenon in 62 patients with coronary heart disease or a greatly enlarged heart who were fitted with an implantable cardioverter-defibrillator (ICD). This allowed the physicians to ‘rescue’ any patient who developed an irregular heart during the study.

About 3 months after the ICD implantation, the volunteers underwent a mental stress test; they were asked to recall a recent situation that made them feel angry or extremely aggravated. During this recall period their T-wave alternans (TWA) was measured; this is a measure of the heart’s electrical instability. Periodic beat-to-beat variations in the amplitude of the T-wave in the electrocardiogram (ECG) are used as a predictor of future heart iregularities in rhythm, in particular ventricular fibrillation, which often precedes sudden cardiac death.

After this test, the patients were followed for at least a year to see which of them had arrythmias (heart-beat irregularities) that had to be stopped by their ICDs. Ten patients who had such arrhythmias had higher TWA amplitudes induced by anger, compared to those without future irregularities. Those subjects with the highest anger-induced amplitudes were more likely to experience arrhythmias in the next year than those with the lowest amplitudes (33% vs. 4%).

The findings demonstrate clearly the link between anger and a heart rhythm response that can lead to sudden cardiac death. There are two consequences: mental-stress TWA measurement should be explored for its suitability as a screening method for detecting patients at risk of severe arrhythmias; and anger-management programs should be recommended more often by family physicians and cardiologists, not just by the courts.