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When someone startles us, we might say, "You almost gave me a heart attack!" But how often do we level the same accusation against deadlines, traffic or other everyday aggravations? Most of us don't realize how taxing chronic stress can be on the body and what a damaging effect it can have on the heart.

How Tension Takes a Toll

Psychological stress activates the sympathetic nervous system, which triggers the release of hormones like adrenaline, norepinephrine, and cortisol. This can cause your heart to race (feel that drumming in your chest?) and certain blood vessels throughout your body to constrict enough to raise your blood pressure. A jolt of adrenaline isn't necessarily a bad thing—it can help you rock a presentation or tear through a to-do list—but when you constantly feel under pressure, you and your heart never get a chance to relax. Stress hormones can also trigger an inflammatory response that leaves blood vessels more vulnerable to damage. The affected areas in turn make a home for plaque to form, which can lead to blockages—by plaque or blood clots—that can cause a stroke or a heart attack. Indeed, research has linked unrelenting stress to an increased risk of heart attack and of impaired overall functioning of the heart.

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An Underestimated Risk
A 2012 meta-analysis from the American Journal of Cardiology that followed subjects for an average of 13.8 years found that those who were chronically stressed had a 27 percent greater risk of coronary heart disease. Putting this in context, the study authors estimate that high perceived stress could be as risky for your heart as a 50 mg/dL increase in LDL (bad) cholesterol or smoking five more cigarettes per day. It doesn't help that stress may make many people crave fatty comfort foods or cigarettes, compounding risk factors.

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The Self Stress Test
Your doctor may not ask about your emotional health as part of routine checkups. So how can you tell if you—and your heart—are feeling especially put-upon?

Here's a self test adapted from the Perceived Stress Scale, a psychological tool that's used in studies to assess how stressful you view your life to be (whether you realize it or not). Start by taking stock of your thoughts and feelings during the past month. Now ask yourself the following questions:
  • How often have I been upset because of something that happened unexpectedly?
  • How often have I felt that I was unable to control the important things in my life?
  • How often have I found that I could not cope with all the things I had to do?
  • How often have I been angered because of things that were outside my control?

    If you found yourself answering "often" or "very often" to most of these questions, it's fair to say you've had a rough month and could be experiencing lingering effects. Your answers don't mean that you or your heart is about to explode—this isn't a diagnostic tool. But it can help you gain perspective and identify when you need to get serious about de-stressing.
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    Don't Lose It, Defuse It
    You can help protect yourself from chronic stress by meditating (take just ten minutes a day to sit quietly and focus on your breath), exercising regularly (aim for at least 150 minutes of moderate activity per week), and getting seven to eight hours of sleep each night. These healthy habits will not only help you manage daily anxieties, but also enable you to deal mentally and physically with major setbacks. If you think your stress is out of control, talk to your doctor, who can recommend a mental health professional or another specialist to help you find ways to cope.

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    Can you die of a broken heart?
    Takotsubo cardiomyopathy is an unusual condition in which heart function is compromised by severe physical or emotional stress (such as the loss of a loved one). More than 80 percent of reported cases occur in women older than 50. The symptoms are similar to those of a heart attack, but while takotsubo cardiomyopathy can be fatal, most sufferers recover quickly.

    Mehmet Oz, MD, is the host of The Dr. Oz Show (weekdays; check local listings).

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