Does High Stress Cause Heart Attacks?

Stress doesn’t just affect your mental health. High stress can increase your risk of having a heart attack, as can a sudden surge of excitement or fear.

Whether it is short-term or chronic, stress can damage your cardiovascular system in multiple ways. Finding ways to address it is important to maintain your heart health.

Acute Stress and Heart Attacks

Acute stress is a sudden, intense reaction to pressure or a threat. It comes on quickly and activates the body’s fight-or-flight response to address the issue or to run from it.

When acute stress hits, the body releases stress hormones such as adrenaline and cortisol, says Michael Blaha, MD, a cardiologist at Johns Hopkins Medicine in Baltimore. Together, they raise your heart rate, cause blood-pressure increases, and constrict blood vessels.

These factors — especially when you already have a buildup of plaque in your arteries — can lead to a heart attack in certain situations, he says.

When stress hits, you may first notice an increase in your heart rate, he says. Although a faster heart rate alone isn’t necessarily dangerous, it reflects how hard you are pushing your cardiovascular system at that moment.

As stress hormones cause your heart to beat faster, they also increase blood pressure and narrow blood vessels, called vasoconstriction.

“Blood vessels constrict to help maintain blood pressure during danger, and that’s a normal and important function,” Blaha says.

For people who already have plaque buildup in their arteries, acute stress can push an already vulnerable system toward a heart attack.

“If someone has a lot of plaque in their arteries already, stress can raise blood pressure, increase clotting, and worsen blood flow all at once,” Blaha says.

In less common cases, vasoconstriction or coronary artery spasms alone may limit enough blood flow to the heart to damage it.

“I’ve seen people who don’t have significant plaque or traditional risk factors develop a small heart attack during extreme stress,” Blaha says.

Chronic Stress and Heart Attacks

Feeling stressed over a long period can directly and indirectly increase your heart attack risk.

• High blood pressure
• High blood sugar
• Increases in bad cholesterol

When your brain senses stress, it sends signals to the bone marrow, the soft tissue inside your bones that makes blood and immune cells. In response, the bone marrow releases immune cells designed to fight threats, triggering inflammation.

“When people are stressed for long periods, they tend to sleep poorly, exercise less, and eat in ways that aren’t great for heart health,” Blaha says.

Broken Heart Syndrome

Stress can also cause a condition known as stress cardiomyopathy, or broken heart syndrome, which has symptoms similar to a heart attack.

Broken heart syndrome typically occurs after an intense emotional or physical stressor, such as the death of a loved one, a serious illness, or major surgery. Symptoms can include chest pain and shortness of breath.

“This is almost an extreme version of what stress can do to the heart,” Blaha says. “If severe stress can temporarily shut down heart function, it helps explain how less intense but more frequent stress can still cause damage over time.”

When to Call the Doctor

• Headaches
• Back and shoulder pain
• Gastrointestinal issues
• Increased blood pressure and heart rate
• Fatigue

“If someone notices new palpitations, irregular heartbeats, or a racing heart that doesn’t settle down, that needs to be checked,” Blaha says.

Managing stress often requires a combination of strategies. Regular physical activity, adequate sleep, and a heart-healthy diet are powerful tools for reducing stress and protecting cardiovascular health, Blaha says.

The Takeaway

• Acute or chronic stress can increase your risk of a heart attack by elevating levels of stress hormones, which raise your heart rate and blood pressure while constricting blood vessels.
• Long-term stress amplifies heart-attack risk factors on its own, and it also can lead to behaviors that further increase your risk, such as drinking alcohol or dropping healthy diet and exercise habits.
• Stress cardiomyopathy, or broken heart syndrome, can occur during intense emotional or physical events and may have the same symptoms as a heart attack.
• Call your doctor if you have serious symptoms of high stress, such as pain and an elevated heart rate, as they may be symptoms of cardiovascular disease.