How are stress and atrial fibrillation connected?
By: Anni Karjala, MD
All of us experience times of stress and hurry in our lives. In the hectic environment we live in, chronic stress becomes a far too familiar companion in our everyday lives. In addition to many other detrimental health effects, stress is known to impact heart health. Reducing stress will protect your heart not only from atrial fibrillation, but from other conditions such as high blood pressure or heart attack.
Patients of mine are often worrying whether psychological stress can be the cause for their atrial fibrillation. In this blog, I will shed light on what we know about the connection between stress and atrial fibrillation, and share a few tips on what you can do to manage stress for the benefit of your heart.
Stress and atrial fibrillation
There’s limited evidence on how significant of a risk factor psychological stress is on atrial fibrillation, but we do know that psychological stress tends to elevate the risk at least to some extent. Stress activates the autonomous nervous system causing the release of stress hormones which can lead to alteration in the electrical function of the heart (1-3). Furthermore, stress increases the risk for other predisposing conditions such as myocardial infarction and high blood pressure, both known risk factors for atrial fibrillation (4). However, stress is rarely the lone cause for an atrial fibrillation episode and other predisposing factors are also often present. Read our blog about how you can reduce your risk of atrial fibrillation.
Atrial fibrillation symptoms and stress
As stress elevates your pulse and increases your blood pressure, it can also worsen the symptoms of atrial fibrillation (5). An episode of symptomatic atrial fibrillation can also be a stressful event, and knowing you have atrial fibrillation can also cause you to worry about your heart, further increasing your stress load – and making you more susceptible for further atrial fibrillation episodes.
The holiday heart syndrome
The connection between atrial fibrillation and stress can also have other pathways. When we’re going through a stressful episode, we often tend to forget our healthy habits and cling on to detrimental ones. In fact, in medical terminology we have a condition called holiday heart syndrome, which often refers to atrial fibrillation caused by increased alcohol consumption and stress levels during the holiday season (6). Stress can thus elevate the risk for atrial fibrillation, not only directly, but also through modifying our health behavior.
How to manage stress?
There are many ways stress impacts atrial fibrillation and how you experience it. Stressing about whether or not your stress could cause your next atrial fibrillation episode is unlikely to make the situation any better. But as we know, managing stress is easier said than done.
Below, I have gathered a few simple tips on things that could help you get started.
(If you have atrial fibrillation as chronic or paroxysmal and you are experiencing symptoms, these tips might be worth trying to alleviate them - but only after seeking proper medical assistance for your condition.)
Meditate. Meditation can help you manage stress which is good for your heart health (7). Try and start with one minute per day - or even breathing slowly and deeply in and out for 10 seconds. You can do it anywhere, anytime.
Sleep. Sleep is the best medicine for many things. In addition to letting your mind pause, it’s the time for your heart rate to drop and your heart to take a rest. Especially in the times of stress, sleeping enough and improving sleep quality e.g. by skipping alcohol is essential.
Take a walk in nature. Walking in nature or even looking at it is known to calm down your autonomous nervous system and reducing stress (8). It’s the perfect time for your mind wander and body to ease off.
If having atrial fibrillation causes you stress or anxiety, let your physician know. The good news is that although atrial fibrillation can be dangerous when untreated, properly managed atrial fibrillation rarely causes complications (9).
Maintain healthy habits, especially during periods of stress. During this holiday season or other stress-intense times, try to remember to give your body - and your loved ones - the best present of a calm mind and a healthy heart.
And last but not least: Identify the source of your stress and reflect how you want to manage it in a way that suits you the best.
Sources:
1) O'Neal WT, Qureshi W, Judd SE, et al. Perceived Stress and Atrial Fibrillation: The REasons for Geographic and Racial Differences in Stroke Study. Ann Behav Med. 2015;49(6):802-808. doi:10.1007/s12160-015-9715-2
2) Tawakol A, Ishai A, Takx RA, et al. Relation between resting amygdalar activity and cardiovascular events: a longitudinal and cohort study [published correction appears in Lancet. 2017 Feb 25;389(10071):804] [published correction appears in Lancet. 2017 Feb 25;389(10071):804]. Lancet. 2017;389(10071):834-845. doi:10.1016/S0140-6736(16)31714-7
3) Svensson T, Kitlinski M, Engström G, Melander O. Psychological stress and risk of incident atrial fibrillation in men and women with known atrial fibrillation genetic risk scores. Sci Rep. 2017;7:42613. Published 2017 Feb 14. doi:10.1038/srep42613
4) Stress related disorders and risk of cardiovascular disease: population based, sibling controlled cohort study. BMJ. 2019;365:l1850. Published 2019 Apr 23. doi:10.1136/bmj.l1850
5) Ladwig KH, Goette A, Atasoy S, Johar H. Psychological aspects of atrial fibrillation: A systematic narrative review : Impact on incidence, cognition, prognosis, and symptom perception. Curr Cardiol Rep. 2020;22(11):137. Published 2020 Sep 10. doi:10.1007/s11886-020-01396-w
6) Brown KN, Yelamanchili VS, Goel A. Holiday Heart Syndrome. [Updated 2021 Jul 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537185/
7) Dossett ML, Needles EW, Donahue Z, et al. A SMART approach to reducing paroxysmal atrial fibrillation symptoms: Results from a pilot randomized controlled trial. Heart Rhythm O2. 2021;2(4):326-332. Published 2021 Jun 22. doi:10.1016/j.hroo.2021.06.003
8) van den Berg MM, Maas J, Muller R, et al. Autonomic Nervous System Responses to Viewing Green and Built Settings: Differentiating Between Sympathetic and Parasympathetic Activity. Int J Environ Res Public Health. 2015;12(12):15860-15874. Published 2015 Dec 14. doi:10.3390/ijerph121215026
9) Brandes A, Smit MD, Nguyen BO, Rienstra M, Van Gelder IC. Risk Factor Management in Atrial Fibrillation. Arrhythm Electrophysiol Rev. 2018;7(2):118-127. doi:10.15420/aer.2018.18.2
