Health Psychology and your Heart

All over the globe people associate love with hearts. If love is lost there is destruction of the relationship. When the physical heart is not pumping oxygen sufficiently there is destruction of cells or no life. The heart is a symbol of life. There is a link between the physical health of the heart and psychology. The heart has many vital functions, and it seems sensible for all to develop distinct ways to sustain its vitality. Discover ways in which to take responsibility for and care of your heart.

Theories about the connection between the heart and mind are in the medical documents throughout antiquity. Some civilizations believed the heart to be the foundation and root of emotions. As Western medicine steadily disclosed this absence of association, notions about the link between the heart and mind went by the wayside. A novel field, behavioral cardiology is attempting to join them together again, this time with reliable scientific strings and this theory is presenting new approaches in the treatment and prevention of heart disease. Heart conditions include the entire cardiovascular system and are the leading cause of death in the United States and are primary determinants of deaths throughout the globe. The Centers for Disease Control and Prevention (CDC) explain that roughly 61 million people in America have heart disease, and the World Health Organization (WHO) states that 29 percent of all deaths worldwide are due to these diseases. The American Heart Association (AHA) continues on to explain that nearly 870,000 people died from heart disease in the United States and accounts for more deaths in females per year than the next six causes combined. To prevent heart disease, recent guidelines emphasize lifestyle modifications.

How the Heart Functions

The heart is around the size of your fist and weighs 300 to 350 grams (11 to 12 oz.) in males and 250 to 300 grams (9 to 11 oz.) in females. This organ quickens up or slows down in response to nerve signals from the brain that interpret degrees of physical exertion. It contracts and relaxes between 70 and 80 times per minute, beats around 80,000 to 100,000 times per day and pumps approximately 2,000 gallons of oxygenated blood throughout the system. This task is without conscious awareness as this organ is a specialized involuntary muscle that continually beats.

Image Creative Commons

The heart made easy discusses that there are four chambers of the heart, 2 chambers on each side. The upper chambers are the atrium, and the lower ones are the ventricles. The heart functions as two pumps for the circulatory system. The right atrium of the heart receives blood which is non-oxygenated then carries blood to the right ventricle into the lungs in which the blood absorbs oxygen. Without oxygen, all cells die. The heart supplies the body with a fresh supply of oxygen and nutrients and assists in removing hazardous waste material. The left atrium accepts oxygenated blood from the lungs to provide all organs and cells of the body with oxygen. This blood also distributes hormones from the glands and nutrients from the digestive system. The cells in the immune system travel throughout the bloodstream seeking out infection, and forwards waste material to the kidneys and liver to be filtered and excreted.


The Hearts Electrical System and the Electrocardiogram (EKG)

The hearts four chambers contract or beat in an orderly manner that has an electrical stimulus. A chamber contracts when an electrical surge moves across a particular path. This stimulus begins in a small collection of unique cells in the right atrium, called the sinus node (SA node). A detonation from these vital “pacemaker” cells causes the heart to contract. These cells in the pacemaker section of the heart generate electrical impulses. The electrical stimuli produced by the cells in the SA node travel through the right and left atrium, causing the cells of the muscle to contract and then it proceeds down the specialized cell passage through the ventricles. The signal’s arrival causes the ventricles to contract simultaneously squeezing and pumping the blood forward along the path.

The hearts physiology determines the route of this electrical stimulation which brings about a coordinated ordered contraction of the four chambers known as the heartbeat. These electrical movements flow through the tissue threads by personal communication from cell to cell via channels, named gap junctions that synchronize the contraction. If the pacemaker misses, the cells do not get their move along commands, and the heartbeat slows down or becomes erratic. New research endeavors to transform ordinary cardiac cells to pacemaker cells by expressing a master regulator gene to replenish those lost by disease or injury. In the absence of an electrical impulse, the heart is relaxed, with the threads held apart by a protector protein termed troponin C. The mysterious ion that produces the contraction is calcium. Every electrical surge discharges calcium that connects to troponin C, and pushes it out of the way to trigger a contraction. However, the calcium is promptly captured and moved back into stores, so the heart relaxes, before the process starts all over again. The EKG measures this electrical heart rhythm and this book discusses when people have this diagnostic examination. Physicians are evaluating the hearts electronic path for manifestations of injury.

Heart functions and The EKG

The EKG Creative Commons

Emotional reactions can alter the heart rate pertaining to this electrical discharge which is the physical connection that relates to psychology. People can learn to regulate emotional reactions, therefore, reduce the stress that it places on the heart and at times reduce heart rates. One example is that the rate of the heartbeat can be regulated and influenced by physical exercise.

How the Heart relates to Blood Pressure 

  1. First Stage (Systole) Is when the ventricles of the heart are squeezing or contracting which results in blood being pumped out to the lungs and onward to the rest of the body. This is the top number of the blood pressure.
  2. Second Stage (Diastole) The ventricles of the heart are relaxing and the atriums of the heart are filling with blood. This is the bottom number of the blood pressure.

The Physical illnesses related to the heart

Cardiovascular disease  made simple in this book includes many disorders. These conditions alter the blood vessels which are veins and arteries leading to and from the heart or the heart muscle. Women who have cardiovascular disease tend to exhibit forms which affect blood vessels while men develop conditions that impact the muscle. These materials discuss conditions such as diabetes mellitus, hypertension, and the debatable hyper-cholesterolemia being causes of cardiovascular disease. The common ailments directly related to heart disease are:

  1. Angina Pectoris is a heart disease that causes severe mid chest pain or discomfort on the left side the chest along with pain in the jaw, throat, stomach, and between the shoulder blades. The thickening of the arteries supplying blood to the heart causes this discomfort.
  2. Aortic Aneurysm is a bulge or out pouching of the main artery, the aorta. These bulges can occur in the abdomen below the kidneys or the chest cavity. The aneurysm occurs when the lining of the aorta becomes weakened and thin by the buildup of plaque. Aneurysms are dangerous because of the possibility of rupturing which causes massive bleeding.
  3. Atherosclerosis is the disease process caused by plaque buildup (cholesterol, fatty substances) in the inner lining of an artery. Over time, the plaque ruptures the lining which in turn produces blood clots. These blood clots inhibit blood flow to the cells causing them to die. Complications of a blocked artery can lead to the development of gangrene, heart attacks and strokes.
  4. Cardiomyopathy in the strict sense means “heart muscle disease” (cardio =  heart, myo  =  muscle, pathy =  disease). Cardiomyopathy is the breakdown in functioning and health of the heart muscle. Those diagnosed are at risk of developing arrhythmias (irregular heart rhythms) that precipitate unexpected cardiac death. There are two types:
  5. Dilated Cardiomyopathy is more common and is when the heart cavity has inflammation. Progression of the disease includes the development of arrhythmias and congestive heart failure.
  6. Hypertrophic Cardiomyopathy is the growth or thickening of the wall between the ventricles creating a blockage in blood flow. Physical symptoms include chest pain, shortness of breath, fainting and dizziness.
  7. Congenital Heart Disease is an error that takes place during the development of the heart during gestation. The blood vessels near the heart or the heart muscle develop improperly. Researchers and physicians often do not understand the basis of these defects, but some attribute the mistakes in development to viral infections or drug and alcohol abuse during pregnancy.
  8. Congestive Heart Failure is a chronic disease that tends to deteriorate over time. CHF is characterized by the hearts inability to adjust to the amount of blood flow in the four chambers. The disease process usually begins with left-sided heart failure and impairs the functioning of the left ventricle. At times, heart failure occurs on the right-side and can at times affect the complete heart muscle.
  9. Coronary Artery Disease is when the arteries around the heart become hardened and narrow because of plaque buildup (atherosclerosis). This gradual buildup of plaque can lead to chest pain, heart arrhythmias, heart failure and heart attacks.
  10. Coronary Heart Disease refers to the hearts inability to provide sufficient circulation to surrounding tissues and the cardiac muscle. It often co-occurs with coronary artery disease. However, coronary heart disease can have other causes, such as spasm. Conditions provoked by CHD are myocardial infarction (heart attack) and angina pectoris (chest pain).
  11. Endocarditis is a well-known condition and is the inflammation of the inner lining of the heart (endocardium). Inflammatory heart disease is inflammation of the tissues surrounding the heart or heart muscle. The most common structures affected are the heart valves.
  12. Heart Murmurs are faulty heart valves, which lead to regurgitation of blood or constrict passage of blood through the valves opening. Heart murmurs can be produced by fevers and toxins during pregnancy. A systolic murmur can be detected when the heart muscle contracts. The diastolic murmurs occur when the heart muscle relaxes in between beats.  Heart murmurs can give out sound remarkably soft to exceptionally loud and the different qualities can be identified and heard using a stethoscope.
  13. Hypertensive Heart Diseases are induced by high blood pressure. Ailments include congestive heart failure, coronary heart disease, cardiac arrhythmias, left ventricular hypertrophy and hypertensive cardiomyopathy.
  14. Peripheral Vascular Disease is of two types. Organic peripheral vascular diseases are abnormal blood vessels surrounding the heart and brain. This ailment can cause narrowing of the blood vessels that supply oxygen and nutrients to the kidneys, stomach, arms and legs. Functional peripheral vascular diseases do not reveal anomalies in blood vessels’ and are produced by spasms. Manifestations include numbness, a cramping pain, and may involve skin discoloration.
  15. Valvular Heart Disease is the process that alters one or more heart valves. There are four primary heart valves which may be influenced by this illness, the aortic and mitral valves on the left side of the heart, and the aortic and tricuspid valves on the right side of the heart.
Photo by Adam Cutler

Photo by Adam Cutler

 The Psychological Factors related to Heart  Disease

The National Institutes of Mental Health (NIMH) states that up to 65 percent of coronary heart disease sufferers who have a history of having a heart attack experience some form of depression. Although these symptoms are not unusual, they should be treated as soon as possible. Major depression can hamper the recovery process and worsen the disease. Prolonged depression associated with cardiovascular disease contributes to subsequent strokes and heart attacks.

People may believe heart disease correlates solely with physical actions (a lack of exercise, poor diets, smoking, excessive drinking), however, attitudes, emotions, and thoughts are equally significant. Thought processes can accelerate the onset of heart disease and hinder taking concrete strides to promote health. A few may sense a loss of control over their life with taking medication, making time for exercise and giving up favorite foods. Making modifications in everyday life is not easy because it takes training to instill these new practices. To sneak a cigarette or cheat on a diet may satisfy an immediate desire, but will hinder the long-term goal of improving health.  Cultivating a healthy lifestyle such as following Dr. Dean Ornish’s program can diminish the risk of heart disease or manage the condition, even if a higher risk is due to uncontrollable determinants such as sex, family history or age.

Psychological determinants can influence health directly (such as stress causing the release of the hormone cortisol) and indirectly (via behavioral decisions) which can harm or preserve health (exercise, diet and smoking). Health psychologists use a biopsychosocial guide in recognizing health practices. This method centers on understanding wellness to be the result not only of biological processes (hormonal and endocrine functioning) but also of mental processes such as approaches toward health and how people cope with stress in their lives. Health psychologists then look at factors that relate to socioeconomic status, culture and ethnicity to formulate treatment plans, interventions and prognoses. Research confirms that while roughly 20 percent of the US population endures an episode of depression in their life, the number soars to 50 percent among folks with heart disease. Long-term investigations report that men and women diagnosed with clinical depression are more than twice as likely to acquire coronary artery disease or experience a heart attack and those with the illness are beginning to give the public advice.

Heart disease has several mind-body associations. Prolonged stress due to difficulties at home or work can contribute to circulation problems that link to high blood pressure and other heart conditions. As with many conditions, the effects on the body vary from person to person. Some manage anxiety to motivate while others may just lose their temper and become frustrated. How people manage tension, influences cardiovascular responses. Studies have shown that if stress makes someone irritable or angry then the individual is more likely to develop heart disease. In fact, how people respond to anxiety may be a greater risk factor contributing to the development of future heart related ailments than high cholesterol or smoking. Clinically depressed people are at substantially higher risk of suffering a heart attack or stroke because they are twice as likely to suffer heart related conditions. Depression can also hamper the aftereffect of a stroke, recuperation from heart surgeries or heart attacks. The immediate shock of coming so close to death along with the stress of possibly having a long recuperation, as well as the fear that another, potentially more dangerous event could occur without warning obviously creates emotional distress.

Kent and Shapiro (2009) found that the pervasiveness of heart disease in sufferers of depression is high, and the connections between heart disease and depression are obvious in investigations of community representations, heart disease patients, and those with depression. They also illustrate the ties between heart disease and psychological determinants involving the Type A behavioral pattern, anger and hostility and fatigue. Understanding and harnessing psychological factors, can improve health by working directly with individual patients, indirectly in large-scale public health programs, or by training healthcare professionals. Health Psychology can be associated with the similar field of clinical psychology, with divisions within health psychology, which, include public and occupational health. The relationship between psychosocial determinants and heart disease is so clear that cardiologists should begin the conversation by questioning patients about stress, energy, mood and support systems. Conventional cardiologists do not, at least not at the time of this writing.

The Psychosocial Factors related to Heart Disease

Psychosocial factors have been associated with increases in tumor necrosis factor, interleukins and C-reactive protein. All of which are signs of increased inflammation, which represents significant parts in developing the artery-clogging disease atherosclerosis. Psychosocial determinants could impact heart disease via a secondary physiologic route, through practices that point toward heart disease or away from it. For example, isolation or depression can hinder people from taking the heart medications they need while a positive viewpoint or active social network can assist people watch their weight or stop smoking. There are plenty of theories of how social situations, behaviors and emotions affect heart disease, however, studies related to stress hormones top the list. Stress hormones speed up the heartbeat, constricts blood vessels and make blood vessels exceptionally reactive to further stress. Psychosocial factors affect heart disease in two fundamental directions. Some add to atherosclerosis, the gradual, destructive means that weaken artery walls and places people at risk for a stroke or heart attack. Others can add to the ultimate insult that triggers a heart assault or stroke.

The Lancet, in 2004, discusses a comprehensive international study affirming that the psychosocial contributions to heart attacks are on a level with obesity, high cholesterol, smoking and high blood pressure. Their conclusions did not just relate to the wild pace world of the West but in China, the Middle East, Hong Kong, Africa and Latin America. Below is a summary of the results:

  1. Anxiety.  Intense fear, the kind associated with heights, crowds, enclosed places, snakes and the like, can at times produce a sudden cardiac arrest. These often-fatal heart attacks occur when the heartbeat abruptly becomes fast and irregular. This touching novel explains one persons encounter with sudden cardiac death in a heart too good to die.
  2. Anger/hostility.  In the Harvard-based Determinants of Myocardial Infarction Onset Study, 1 in every 40 heart attack patients report an incident in agitation in the two hours before the heart symptoms development. Anger can trigger heart attacks. Atherosclerosis appears to progress faster in people who score high on hostility or anger ranges.
  3. Depression.  Folks who display the symptoms of depression after a heart attack, stroke, heart surgery, or the onset of heart failure do not  manage as well as those who are not exhibiting signs. Indications of depression, as well as full-blown major depression, contribute to heart disease.
  4. Unexpected emotional stress.  Sudden emotional disturbance can set off a critical, but reversible heart failure named broken heart syndrome. Researchers at Johns Hopkins have documented its occurrence in people after a loss in the family, a surprise party, a burglary, a car collision, and even fear of talking in public.
  5. Chronic stress.  Persistent stress that associates with a shaky marriage, financial difficulties, work, taking care of a parent or spouse, or residing in an unsafe community correlates highly with the appearance of heart disease. People that have chronic stress also have challenges with rehabilitation, after a diagnosis of a heart condition.
  6. Social supports.  Social isolation is nearly as significant as high cholesterol, high blood pressure, and smoking at predicting long-term survival, among heart attack victims.
Photo by Erica Walker

Photo by Erica Walker

Heart Disease Risk Factors

Genetics’ or a positive family history of chronic heart disease is known to increase the risk, however, there are ways to beat the heart attack gene.

Hypertension or elevated blood pressure accelerates the atherosclerosis process especially if hyperlipidemia or high triglycerides are present. This combination plays a significant role in development of heart attacks. However, heart attacks can be prevented and managed if people are diagnosed early and if they understand the recommended dietary treatment plan and follow instructions.

Diabetes Mellitus The risk of developing a severe heart disease is two to three times more among diabetics. Type 2 Diabetes is a highly preventable disease.

High Cholesterol (Normal <200 mg/dl) Cholesterol has two components, the low density lipoprotein (LDL) and high density lipoprotein (HDL). LDL is the most directly associated with Coronary Heart Disease.  However, High density lipoprotein (HDL) cholesterol is considered to be protective against development of Coronary Heart Disease. (It should be more than 40 mg/dl).

Oral Contraceptive Pills lead to higher systolic and diastolic blood pressure which in turn increases cardiac risk.

Being Overweight is associated with high rates of cardiovascular deaths and heart failure with different rates among men and women. Obesity affects the blood pressure, increases levels of lipids in the blood, and increases the risk for developing Type 2 Diabetes.

Smoking The toxins in the cigarettes are considered to be one of the main causes of development of atherosclerosis. Atherosclerosis is a thickening of the walls of arteries which result from the accumulation of fatty plaques, scarring and hardening of the walls.

Physical Inactivity is associated with high risk because inactivity increases the lipid levels in the blood. Physical inactivity and diet are considered to be leading causes of obesity, lipid panel abnormalities, elevation of blood pressure and diabetes mellitus.

Alcohol Intake of more than three drinks a day has a harmful effect on the heart muscle. Heavy drinking raises the triglyceride level by supplying excess fats into the body circulation. Over time, heavy drinking can damage the heart and leads to high blood pressure, stroke and congestive heart failure.

Multiple Risk Factor Combinations   Increased body weight is a good example of a risk factor for heart disease that plays a role for development of other risk factors, like increased lipids level in blood (hyperlipidemia), elevation of blood pressure (hypertension) and other diseases like diabetes mellitus. Multiple risk factors significantly increase one’s chances of developing heart disease.

Tips on How to Prevent Heart Disease

  1. People are in command. The mind reports to the body and the body reports to the mind. Everyone can learn to manage their mental self-talk to improve health.
  2. Take time out each day to relax. Begin to take note of things that cause stress. Try to accept the fact that some situations are not reversible
  3. Take responsibility and care for the body. Get enough sleep. Exercise on most days. Eat a healthy diet. Monitor your blood pressure daily.
  4. Control stress at work. Leave work at lunchtime and take a short walk or relax outside the business environment. Take a 15-minute leisure break to practice a relaxation exercise. Switch from caffeinated to decaffeinated coffee or herbal tea.
  5. Get the help. If people have a hard time managing the stress alone or are using habits, such as drugs, alcohol or cigarettes, to diminish the tension, they may require help discovering ways to regulate anxiety. Here are a few of the many possibilities: Individual counseling, Group counseling, Support groups Self-help books, Stress management courses.
  6. Take control over the schedule. Prioritize what needs to be done every day.
  7. Avoid negative self-talk. Try not to concentrate on situations in which there is no control. Take a moment to give yourself recognition for jobs well performed.
  8. Learn relaxation Techniques and Applications. There are many techniques, mindfulness, yoga, visualization, deep relaxation and focusing to name a few.

In conclusion, the stopping of the heart beat always results in death and people have applied this concept today using everyday language that associates with love. People link love with hearts, if there is no love there is destruction of the relationship. When the heart is not pumping oxygen adequately, there is destruction of cells or no life. It seems reasonable for all to develop new ways to maintain its strength and learn how to take care of our hearts. Health Psychologists enhance the recovery of cardiac patients by providing tools to cope and ways to manage the physical changes that associate with the disease. Health Psychology for Everyday Life focuses on primary and secondary prevention of heart disease that will assist you in utilizing strategies to address the emotional and behavioral barriers in making lifestyle changes. This is the work of the health psychologist who utilizes a biological, psychological and sociological approach strategy.

Live Well

© Dr. Cheryl MacDonald

Health Psychology for Everyday Life, the book

Video of Health Psychology and Therapy

Health Psychology       Cheryl Ann MacDonald, Psy’D.

       Health Psychology of San Diego

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Top Image Credit to Jonathon Rosen of Beautiful Pathologies


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