Patients with an established diagnosis of depression and/or anxiety have a four times higher risk of presenting heart or blood vessel problems. Stress is also a clear cause of acute myocardial infarction or coronary spasm, which is a sudden and temporary narrowing of one of the coronary arteries that bring blood and oxygen to the heart.
Cardiovascular disease is the leading cause of death worldwide. It develops when there is damage to the heart due to biological issues, which are sometimes genetic, but others due to lifestyles and associated risk factors, due to the type of activity styles and associated risk factors, due to the type of activity people engage in.
There are real and "felt" emergencies; in the latter case, it is, for example, a pain in the chest that makes us believe that we have a heart problem; cabinet and laboratory diagnoses indicate if there is indeed one. However, when there are undiagnosed symptoms, as in this case, the mental and emotional part "works".
Even though heart disease can't be called psychosomatic as a whole, some of its symptoms can be.
Sometimes there is post-traumatic stress due to having been in intensive coronary therapy; patients come for psychiatric consultation after having been hospitalized, with memories of the catheterization and of having almost lost their lives, and require follow-up. In the first month, 20% to 25% of people experience depression. Also, if the patient shows signs of anxiety or depression that aren't picked up, likely, they won't take their medications as prescribed.
What happens in the psyche of an individual who, even knowing that he or she has a disease, prefers to "die happy" and eat what he or she wants, rather than modify his or her diet? Many patients are anxious, and depressed, with a poor support network, and they need the physician to provide them with information with empathy.
Throughout a lifetime, risk accumulates that at one point detonates into a cardiovascular event or disease, such as a heart attack, heart failure, arrhythmias, and multiple pathologies that lead to death.
Some asymptomatic patients present to the office with high blood pressure or some are not hypertensive but, due to stress, have a hyperreactive condition that causes them to have high blood pressure. This hyperreactivity eventually leads to cardiovascular disease.
For example, the so-called "broken heart" disease is a condition often caused by stressful situations, which can lead to heart failure. Regarding the COVID-19 pandemic, physical deterioration and cardiovascular disease manifest themselves more, to the extent that a person has a greater number of infectious processes.
Risk factors such as dyslipidemia (or elevated levels of cholesterol or fats in the blood), obesity, sedentary lifestyle, genetic factors, and endocrinological alterations add up until the moment when cardiovascular disease is triggered. But this can, in turn, lead to mental illnesses such as depression and anxiety.
In these conditions, there is an alteration of substances in the brain that triggers an inflammatory phenomenon; the release of cortisol and adrenaline has repercussions on cardiovascular health since, for example, vasoconstriction is generated that alters the coronary arteries and this can trigger a heart attack.
If we have high levels of serotonin, there is greater platelet adhesion and a greater risk of thrombus formation, which can lead to myocardial infarction or cardiovascular disease.
Preventive measures should be promoted so that as few cases as possible reach the highest specialty. General practitioners, internists, and psychiatrists should attend to these patients, taking into account that they are not the only heart or only brain, but that both aspects may be influencing each other in a bidirectional way.