can stress cause a heart attack?

Alt text: Man sitting on his bed at night, one hand on his chest, looking at his phone

Many people wonder whether stress can cause a heart attack, especially when their heart races or their chest feels tight during a difficult week. When work deadlines, money worries or a family crisis keep your heart beating fast long after you go to bed, it is natural to ask what that does to your heart over time.

Stress has been linked with heart attacks, but the link is not simple. Stress is usually one factor among several, and heart attacks linked with stress mostly happen in people who already have heart disease or risk factors such as high blood pressure. Which checks suit you depends on your age, medical history and other risk factors, and a heart screening often starts with simple measures such as blood pressure and cholesterol.

In this article we explain how stress may contribute to a heart attack, its longer-term effects on the heart, the risk for younger adults, palpitations and the chest symptoms that need emergency care.

How Is Stress Linked to a Heart Attack?

Stress may play a part in a heart attack through the stress hormones adrenaline and cortisol, which raise your heart rate and blood pressure and may make your blood more likely to clot. In the short term, these changes help your body react to danger, and in a healthy heart they usually pass without harm.

The risk is higher when the coronary arteries, the blood vessels that supply the heart muscle, are already narrowed by plaque (a fatty buildup in the artery wall). A sudden rise in stress hormones is thought to be one of the things that can make a patch of plaque crack. If that happens, a blood clot may form over the crack and block the artery, which stops blood from reaching part of the heart muscle.

Intense anger, grief or shock has been linked with a higher risk of a heart attack in the hours that follow, especially in people who already have heart disease. For most people, though, the risk from a single stressful moment is small.

What Are the Effects of Stress on the Heart?

The effects of stress on the heart usually develop over months or years, and long-term stress has been linked with a higher risk of heart disease and heart attack. In one large international study of about 25,000 people in 52 countries, people who had had a heart attack were about twice as likely to report constant stress at work or at home as people who had not. This shows a link, but it does not prove that stress caused the heart attacks.

Long-term stress is thought to affect the heart in three main ways:

●       Higher blood pressure – when stress continues for months, stress hormone levels can stay high, which may contribute to high blood pressure.

●       Unhealthy habits – many people sleep less, smoke, drink more alcohol or stop exercising during stressful periods, and these habits can raise the risk of heart disease.

●       Inflammation – ongoing stress has been linked with inflammation in the blood vessels, which may add to the plaque that narrows the arteries.

Habits can change, though, and regular exercise, enough sleep and talking to a friend, family member or counselor about stress may help lower the effect of stress on your heart.

Can a Young Person Have a Heart Attack From Stress?

Alt text: Woman checking her blood pressure with an upper-arm cuff at a kitchen table

A young person can have a heart attack linked with stress, but stress alone is unlikely to cause one in an otherwise healthy heart. Even in adults under 40, most heart attacks involve narrowed coronary arteries, often alongside smoking, high cholesterol, diabetes, obesity or a family history of early heart disease.

High cholesterol and high blood pressure often cause no symptoms, so some younger adults may not know they have them. In a younger adult who already has narrowed arteries, a stressful period may be one of the factors that leads to a heart attack.

Spontaneous coronary artery dissection (SCAD), a tear in the wall of a heart artery, can cause a heart attack even in people with normal cholesterol and blood pressure. SCAD most often affects women in their 40s and 50s, and it can also happen during or soon after pregnancy. Some SCAD episodes have been reported after extreme emotional stress or intense physical exertion, although the cause is often unclear.

Does Stress Cause Heart Palpitations?

Stress can cause heart palpitations, and they are one of the more common ways people notice stress in their body. Palpitations can feel like a racing, pounding or fluttering heartbeat, or as if your heart has skipped a beat.

Adrenaline makes the heart beat faster and more forcefully, so a racing heart during a stressful moment is often a normal response. A normal resting heart rate for adults is 60 to 100 beats per minute. During stress or anxiety, your heart rate can rise above that for a while, and it usually returns to normal once the stress passes.

Stress-related palpitations are often harmless, but a doctor should check them when they are new, keep coming back or last more than a few minutes. Palpitations that come with dizziness, fainting, shortness of breath or chest pain should be medically assessed straight away, because these symptoms can be a sign of an irregular heart rhythm (arrhythmia).

Is It Stress or a Heart Attack?

Alt text: Body outlines with the chest, arms, neck, jaw, upper back and stomach shaded

Stress and a heart attack can both cause chest pain, a pounding heart and shortness of breath, so it can be hard to know which one is causing your symptoms without a medical assessment.

Heart attack symptoms can also be milder than the sudden, crushing chest pain shown in movies, and the warning signs include:

●       Chest discomfort – pressure, squeezing, fullness or pain in the center of the chest that lasts more than a few minutes, or goes away and comes back.

●       Upper body pain – pain or discomfort in one or both arms, the back, neck, jaw or stomach.

●       Shortness of breath – with or without chest discomfort.

●       Nausea and lightheadedness – sometimes with a cold sweat.

Women are somewhat more likely than men to have shortness of breath, nausea, or back or jaw pain, sometimes without obvious chest pain.

Because stress and heart attack symptoms can feel alike, any of these warning signs needs emergency medical care straight away, even if you think stress is the cause. It is safer to have a heart attack ruled out than to wait and see.

In Closing: Small Changes for a Healthier Heart

A stressful week is unlikely to cause a heart attack on its own. Heart attacks linked with stress mostly happen in people who already have narrowed arteries or high blood pressure, and both can often be managed once they are found.

Small changes such as moving more, sleeping well and talking to a friend about stress may help protect your heart. If you are unsure about your heart health, your doctor can advise which checks suit your age, medical history and risk factors. From there, you can make changes with confidence and look after your heart for many years to come.

Disclaimer: This article is for general information only and is not medical advice. Please speak to your own doctor about your heart health and any symptoms you have.