- NEW YORK (Reuters Health)
- Keeping feelings of stress and anger at bay may lower the risk of sudden
death in heart patients with an implantable defibrillator, new study findings
suggest.
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- The medical device, also known as an implantable cardioverter-defibrillator
(ICD), is placed in the heart of a patient with an abnormal heart rhythm.
The device detects heart rhythm abnormalities, and releases an electric
impulse to stabilize the heartbeat. These abnormalities can lead to sudden
death if normal heart rhythm is not restored.
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- Previous research has shown that emotional and physical
stress can tax the hearts of both cardiac patients and healthy individuals.
Working patients wearing ICDs are more likely to experience a rapid heartbeat
on Mondays, for instance, and medical interns are more likely to have abnormal
heart rhythms while they are on call.
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- To investigate emotional and physical triggers of abnormal
heart rhythms, or arrhythmias, in a group of patients with ICDs, a team
of researchers followed 240 people over 3 years. All patients kept diaries
of their mood, activities and level of physical exercise rated on a 5-point
intensity scale, with 5 indicating the most vigorous activity. Patients
who had an arrhythmia over the course of the study also recorded their
mood shortly beforehand, and again 1 week later at the same time.
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- Feelings of anger and any level of physical activity
increased the risk of needing a shock to restore normal heart rhythm, according
to the findings in the October 1st issue of Circulation: Journal of the
American Heart Association. Among patients who received a shock, anger
was rated at 3 or higher in the 15 minutes preceding the shock in 15% of
cases, compared with 3% of the time the following week. These patients
reported that they had been arguing, gambling, driving or had just heardbad
news when the shock was delivered.
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- Other emotions such as anxiety, sadness, happiness or
feelings of being in control or challenged did not affect the risk of arrhythmia,
however, the report indicates.
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- Patients were also more likely to receive a shock when
they were walking, engaging in physical activity at work or exercising,
according to the research team led by Dr. Diwakar Jain from Hahnemann University
in Philadelphia, Pennsylvania.
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- Jain, in an interview with Reuters Health, stressed that
these patients can exercise under medical supervision at a cardiovascular
rehabilitation program.
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- "Low-level, carefully titrated physical exercise...is
beneficial for these patients," he said.
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- And while it is not clear whether moderating feelings
of anger would have any effect on patients who wear ICDs, some studies
have shown that stress management and anger-reduction interventions can
lower the risk of repeat cardiac events.
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- "I strongly think that comprehensive behavior modification
therapy may have an important role in patients with ICDs or in those with
ventricular arrhythmias and in patients with coronary artery disease in
general," Jain told Reuters Health.
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- SOURCE: Circulation 2002;106.
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