This World Heart Day, Smile, it keeps cardiologist away- Dr B Hygriv Rao

It is being increasingly recognized that psychological emotions have a strong connection with the wellbeing of heart and negative emotions may be related to the occurrence of heart diseases. Development of heart failure in an otherwise normal person following an emotional trigger like the loss of a loved one is recognized as a specific entity called Takatsubo Cardiomyopathy and is aptly called broken heart syndrome. It was first recognized in Japan but has been identified elsewhere too including in India. Extreme mental stress leads to a massive surge of hormones like adrenaline and norepinephrine resulting in the ballooning of the apex of the heart muscle. This causes chest pain and heart failure which is fortunately reversible with treatment. Though this syndrome may be a more dramatic presentation of mental stress, psychological emotions like sadness, anxiety, internal conflicts lead to increased cardiac events. The emotions of anger, hostility, stress, and depression have been clearly associated with heart attacks. It is also known that sudden deaths can be triggered by emotional stress and extreme anxiety.

The absence of distress is not equal to psychological wellbeing. It is itself an independent predictor of health. Recently American Heart Association has proposed a term called cardiovascular Health (CVH) which includes 4 health behaviors- Healthy diet, physical activity, no smoking and normal weight appropriate for height (BMI) AND 3 health factors- Favourable blood pressure, normal blood sugar, and cholesterol. Good CVH denotes freedom from cardiovascular diseases and improved longevity of life and also lesser chronic diseases and slower aging. To a large extent CVH is related to psychological wellbeing. People who are happy are more like to physically active and follow a healthy diet & lifestyle. Such people are more inclined to be compliant to medications and more motivated to keep health parameters like diabetes and blood pressure in control. Of various factors denoting psychological health, optimism is one factor strongly associated with good CVH. A study involving about 70,000 women showed that optimism reduced heart related mortality by 38% and stroke-related deaths by 39%.

Apart from taking medications, it is important to aim for psychological wellbeing. To approach each moment with openness, curiosity and without judgment is the first step. Mind body techniques like Yoga, deep breathing exercises and progressive muscle relaxation promote psychological well being. Meditation, in addition, has been recognized to reduce mortality in patients with heart diseases. These interventions have improved negative symptoms like anxiety and depression, helped to improve physical activity, follow more disciplined medication regimen leading to better health parameters.

Promotion of optimism and feeling a purpose in life are other important objectives to achieve for a psychological well being. These can be attained by recalling positive life events, writing regarding a better future, expressing gratitude, practicing forgiveness, planning and performing acts of kindness. Patients particularly elderly often feel the loss of purpose in life. A sense of belonging to a group is very important to combat this negative emotion. This can be the workplace or a senior citizen group, spiritual groups, a group of individuals with similar issues forming a support group and more importantly the immediate family. Family instills in the mind a feeling of being wanted, a sense of achievement and purpose.

The key to good cardiovascular health and a longer life free of disease is psychological and emotional wellbeing. Enthusiasm, optimism, and contentment lead people to express positive emotions like happiness. Cheerfulness and enthusiasm at work reduce stress levels, instills positive psychology which is infectious contributes to a healthy heart is a happy mind. Useful tips are to Recollecting happy experiences, Planning but avoiding anxiety about tomorrow, Resisting the emotion of anger and hostility to others, productive usage of time, seeing good side of every event, visualize one's best self and being optimistic.

Dr B Hygriv Rao (the author) is a Senior Consultant Cardiologist & Electrophysiologist at Krishna Institute of Medical Sciences (KIMS) Hyderabad.