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A podcast by millennials, for millennials, covering health challenges unique to Gen Y. Get expert insights, practical patient advice, and inspiring survivor stories to help you make informed healthcare choices. Empower your journey with YMyHealth!
Melissa Schenkman (00:41)
It's February, which is Heart Month, and one of the big topics a lot of us hear about a lot is how stress affects the heart. And so many millennials are stressed all the time for lots of reasons, but a lot of us don't know what it is that affects the heart, that there are certain types of stress, but really even what's going on in the body from what we're experiencing that's causing stress in our lives that can really be bad for heart health. And so...
Today we have Dr. Garrett Ruth with us, who is a cardiologist out of South Carolina on the podcast. So welcome to the podcast.
Dr. Garrett Ruth (01:16)
Thanks for having me, appreciate it.
Melissa Schenkman (01:18)
Very welcome. Thank you for making the time to come in and talk with us. And we'd love to start by just kind of hearing your thoughts on like, what is this connection between stress and the heart that we hear about? What's kind of going on in the science behind all of that?
Dr. Garrett Ruth (01:32)
Sure, yeah, and like you said, stress is a daily part of life, some more so than others, which may influence all this, the degree of stress you experience in your lifetime. But certainly, I like to think of, in the cardiac physiology, there's two really types of stress. You have your chronic, everyday stress that's just in the baseline background, and then you have what we call an acute stressor,
which is a very significant event, more so than your basic stressful events on your day-to-day basis.
So kind of breaking those two down, I'll start with the one we all experience, which is kind of chronic stress, which this stress comes in every facet. Sleep deprivation, work stress, emotional stress, you name it, all of those things encompass and really go into the path of physiology to start and not to get too deep into it, but, but the stress hormones are what's released in your body when you're under this great deal of stress.
Your catecholamines are these endogenous hormones that are secreted from your adrenal glands. Your fight or flight system you'll commonly hear in biology or your rest and digest system are becoming basically stimulated too much. It then releases cortisol in the blood. That leads to a host of different hemodynamic effects. that's to increase your blood pressure, increase your...
heart rate, the same thing as the same course as the adrenaline that you'll talk about. And that's what's released in a steady state over the course of time.
And that leads to multiple changes, not just related to the heart, but in regards to the heart, again, back to the blood pressure, blood sugar goes up. That in turn leads to cholesterol and triglycerides in place. So we're talking about, again, chronic. So over the course of months to years, that's increasing inflammation and it's increasing your cholesterol levels, plaque deposition, you name it, which in turn brings to all the problems that you one would expect that you develop in your 30s, 40s, 50s and so on, progressive coronary disease and all the things that come in between. So that cortisol level, that baseline stress comes in many, many fashion, but it all leads to the same thing at the end of the day with that increase in stress hormones. then..
Melissa Schenkman (03:42)
That's a lot. To think about it, I was going to say, just talk to for a second, that's so much, I think we don't realize that all of this is going on during, as we're experiencing this over time, which so many people do to your point, that's a lot that can happen.
Dr. Garrett Ruth (03:57)
Yeah, and again, like you said, stress starts when you're a kid and it goes on up and up and so forth. Managing that on day-to-day basis is very important because it can lead to adverse outcomes as you get older and we see it firsthand.
But then talking about the more acute stressors, which are obviously more...hopefully rare for most people, they can actually lead to traumatic events or whatnot, can lead to plaque rupture events inside the heart, and that can lead to an acute heart attack. It's rare, but it certainly happens. Your blood pressure rises acutely, and then that puts shear wall stress on the arteries of the heart, and it can lead to a tear in the inner lining of the heart, and then you're coming in with a major heart attack. We see that from time to time.
And then even outside of the...blockages and heart attacks, can induce electrical problems in the heart. Arrhythmias can come out. We see that very, actually very commonly. Somebody's under a great deal of stress for whatever reason, and the most common abnormal heart rhythm is atrial fibrillation, and then people come to the hospital after that, and we see that very, very commonly in the acute stressors that provoke these various problems to come out all of sudden.
Melissa Schenkman (05:12)
Wow, and I think it's really interesting for us at this age to think about that this can happen to us because of the amount of stress we're under. This is not something that's a 50 and over thing. This is something that can affect us and when you're talking about far as acute stressors, one of the things that really makes me think about not only are millennials who are parents who have different things that can happen with their kids, but also we have such a rise in the number of millennials who are caregivers to parents or to older adults like...
astronomical compared to any other generation. And so it's making me think about that very much. had something recently with one of my parents who ended up in the ER. And so it's making me think about that. And I was one who was there for many hours with all that and they're okay, thankfully. I'm sure my blood pressure and my heart rate was rising even though I wasn't a patient. Yeah.
Dr. Garrett Ruth (06:05)
A hundred percent. And if you think of that happening, you know back to the chronic if that's happening all the time or you're always stressed your blood pressure's up your heart rate's up the Inflammation is up in your body and that leads to all these things that we don't want to have happen as you as you age for sure definitely.
Melissa Schenkman (06:22)
Definitely. I think on the other side of the fact that we are experiencing so many different types of stress these days, there's also, we're very fortunate there are all these different wellness practices that can help with that. And so that's one thing I'm curious about. We talk about how people go do yoga, go do meditation, do these things with some of your patients and especially those in this age group of people. you find those are helpful things to try and prioritize it to reduce stress?
Dr. Garrett Ruth (06:52)
100%. And it's really a, it's a multidisciplinary approach. It's not just one thing I would say. And it's really catered to the person. Yoga, meditation, know, certainly exercise, exercise. It just depends on the person really. And, and I've had various people try various different things and they work with their primary cares as well. If it gets overwhelming to the point psychiatry, psychologist, and, just every person has a different.
different approach on how they deal with stress and some may work for others that don't work as well for others and just kind of catering and figuring out what's best for you to achieve that is kind of what we'll always talk about in our various visits and clinic.
Melissa Schenkman (07:33)
That's really good to hear because I think one of our biggest struggles is we know we have something that we should deal with because there can be long term consequences. But with people's schedules and a very full plate, it's hard to make time for that. so knowing how significant and I know you this firsthand. being able to know and to hear this from you that
It does help and how important it is to take and reduce your stress and try different ways of doing that for the heart.
Dr. Garrett Ruth (06:52)
Yeah, 100%. Mental health used to be somewhat of a stigma, you know, 10 years ago. and thankfully, as of recently, that is less of a stigma, at least in my view. There's still things that go along with it. But at least now we are now identifying this as, yeah, it's okay to go to a psychologist. It's okay to take a rest day, a mental day if you can. It's certainly okay. And it's advised in these situations. So at least that's becoming more of the norm these days I would say.
Melissa Schenkman (08:35)
Yeah, absolutely. And I very much credit our generation with that because people are very open to talking about that. I know we've had multiple Why My Health contributors who've told us how effective going for therapy has been for them in addition to also making time every day to meditate or several times we need to do yoga and that they needed that combination of all of that to be able to reduce their stress and I think so many people do.
Julie Woon (09:02)
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Melissa Schenkman (09:56)
And it's very interesting that of all days, there happens to be a new study that came out today that we're going to talk about as well. I know it's like they knew that we were going to be recording this episode and it comes from the Journal of the American Heart Association. You can't get much better than that. when it comes to the heart. Yeah, exactly. Very reliable resource to say the least. so this study, and we can put a link to the study in the show notes, definitely for people to check out.
The title of it is Cardiovascular Reactivity to Mental Stress and Adverse Cardiovascular Outcomes in Patients with Coronary Artery Disease. And coronary artery disease covers a very kind of a large spectrum of things. everything from even your high cholesterol when you think about it. I guess as I'm thinking, trying to put myself in the shoes of others who will be listening to us, you'd say, gosh, well, how can like… my high cholesterol be affected by mental stress and then further affects my heart. So this is an interesting study on that. And so I'd to kind of hear your thoughts on this one.
Dr. Garrett Ruth (11:09)
Yeah, so what they kind of try to simulate is putting two cohorts of patients undergoing various levels of stress. They all have this diagnosis like you said of coronary artery disease, which again is a very broad definition, but they've at some point been diagnosed with a heart attack or they've been diagnosed with medical coronary disease by imaging or some way.
Not to go on the deep pathophysiology of it, but the endothelium of the vascular tissue in your body, most notably we're talking about the heart, which is the inner lining of the vessels of the heart that provide your heart with blood, play a very significant role in all of this. And that's what they're testing is the vasoreactivity and how it responds to stress. They try to put a blood pressure cuff basically on these various patients after undergoing some mental stress.
And then they basically inflate that blood pressure cuff up and then they deflate it and using ultrasound, they're actually able to measure how much of vasodilation or what would just widening of the arteries occurs thereafter. And that's under various mechanisms of all these things that I won't get into in the biochemical pathway. But it's a degree of how well our heart responds to stress and how the endothelium does. And that also translates to inflammation.
And inflammation is one of the heavy roles that we play here. So then they go in on a bout and they measure what happens to them in four or five, six years, I forget the exact length of the trial, but they're able to say that those people who were under great deals of stress and their vasoreactivity was poor by that ultrasound study, they have had decreased or increased risk of major cardiovascular events which encompasses stroke, heart attack, and certainly mortality of death.
And they have a pretty good correlation. It's a small sample study, at least as far as their information is concerned and their data, there's some one-to-one correlation of their adverse outcomes moving forward. So it's an interesting study. There's a lot of nuances that would have to be really tied out to fully associate, but at least this gives us a view on, hey, we have data here that tells us that...
When we put these people under stress and we see how their body responds to it, the people who respond poorly clearly have a one-to-one correlate bad outcome moving forward. So it kind of just solidifies what we already kind of assume. It just gives us an objective finding. So interesting, interesting study.
Melissa Schenkman (13:29)
It really is because it really makes us think about how much the coronary artery disease matters in relation to stress. Like how much stress actually can affect it, even with it being, I agree, with being a smaller sample size. still pretty, there were, I'm looking again right now here at the site, there were about 629 patients.
Now that's not thousands and thousands of people, right, everyone? it's still a nice number to be able to say, like, this is a very interesting finding and something to think about. So I think for a lot of us, this is very helpful to hear because there's, guess the idea sometimes, especially in this area, is that this idea of stress and this organ that's this incredibly important organ, but organ nonetheless, that is in your body, it's so abstract, right? For a lot of people. And so I think this between everything.
that you have shared with us as far as the pathophysiology and then looking at this study and other really wonderful insights you provided. really helps us to see stress even though it's this thing we can't see, it has a really powerful effect.
Dr. Garrett Ruth (14:40)
It's the objectivity to the subjectivity, which is one of the main reasons I went into cardiology is because it's a very objective field.
Melissa Schenkman (14:50)
I can see that, absolutely. Absolutely. Well, just to wrap up on this particular topic, what are some things that you usually recommend to your patients when it comes to stress? And I know there are so many different types of patients that you see with different levels of coronary artery disease. What are some of the things you find that you've just seen clinically to be really useful and for us to think about?
Dr. Garrett Ruth (15:15)
Well, in the realm of stress, I'm focusing, again, it's a multidisciplinary thing, but for me, at least in the time that I have with my patients, I focus on, again, like you said, sleep is important. I think getting seven plus hours of sleep, if not more, certainly benefits the cardiovascular system, reduces the amount of inflammation, reduces the amount of stress amongst a host of other things. That in turn leads down to bring down your blood pressure, all those things.
Exercise. I mean exercise as a stress reliever you get amount of studies you can get your your recommended 75 minutes three times a week of vigorous activity or less vigorous doing 120 what so on so forth is I think you're getting so much benefit not just cardiovascular stress weight management all of these things those are the big things I'll talk about is sleep related issues as it relates to hypertension and cardiovascular disease and certainly getting into your exercise. It's so important.
You always hear, oh yeah, you just need to work out, and you feel better and you're healthier. But if you look at the data behind it, it's vitally important as you start to get older and can you keep active? My people that I've seen, they're 90 and I see even 104. I saw her a couple of days ago, 102, 102. She turned 102 and she just stayed active. I mean, think that's obviously there's a lot of things at play to live long.
Melissa Schenkman (16:31)
Amazing.
Dr. Garrett Ruth (16:37.346)
longevity but staying active is the common denominator I see in my 90, 100 year olds that are doing well. So you know a lot of things can be talked about this but those are the ones I really try to harp on with my patients.
Melissa Schenkman (16:51)
Well, that's wonderful to hear. If that isn't a motivator to get you to exercise and the time, hearing that there are people who are 90 and here beyond 100 and they took that time throughout their life to keep and stay active, that certainly motivates all of us to do the same. Well, thank you so much for taking the time and sharing all this very, very helpful information with us.