Anger Can Trigger An
Irregular Heartbeat

By Suzanne Rostler

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.
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.
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.
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.
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.
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.
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.
Jain, in an interview with Reuters Health, stressed that these patients can exercise under medical supervision at a cardiovascular rehabilitation program.
"Low-level, carefully titrated physical beneficial for these patients," he said.
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.
"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.
SOURCE: Circulation 2002;106.
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