In medical matters of the heart, your mind can be either your best friend or your worst enemy. What you think and feel, and how well you deal with those feelings, can affect your physical health in myriad ways.

The connection between your state of mind and the state of your heart is complex. Some effects are direct and dramatic. Others are less direct but potentially just as profound. Here are some of the emotional factors considered most likely to influence your heart's health:

This is the body's natural response to threats, also known as the fight-or-flight response. In primordial times we may have used it to react quickly when confronting a saber-toothed cat. Nowadays, we may experience it when someone cuts us off in traffic, or when we're fighting podium terror before a speech.

There's no missing the mind-body link here: As you feel a burst of fear or rage (or both), a surge of adrenaline is released into your heart. Your blood pressure rises, your muscles tense and your blood vessels contract. Your blood platelets become stickier, to improve clotting (just in case that saber-toothed cat catches up with you). Your heart speeds up and consumes more oxygen—which in turn puts pressure on the coronary arteries. If those arteries can't get enough blood to the heart, you may have angina or chest pain.

When the danger or excitement is past, your body relaxes. Or at least it should. If you have trouble working off the tension of life's daily crises and frustrations, you may be putting your heart at risk with lower-level but constant stress. It's not clear if this form of stress directly causes heart disease, but it can't help. That's why stress management is a key part of cardiac rehabilitation programs.

Clinical depression (shown by symptoms such as persistent sadness, fatigue and insomnia) is a serious danger for heart patients. It's all the more treacherous because it's often not recognized and treated. The National Institute of Mental Health estimates that about one in three people who have survived a heart attack experience major depression in a given year.

Studies show depression raises the risk of second heart attacks and increases a patient's disability. It may do this, in part, by acting directly on the body in ways similar to stress—by making platelets sticky, for instance. The indirect effects are easier to trace. Depressed patients are less motivated than psychologically healthy ones to follow the orders of doctors, nurses and other caregivers. They're more likely to abuse alcohol, eat unwisely or fail to get enough sleep.

Social isolation is not in itself an emotional illness, but it contributes to others, such as depression, that can afflict heart patients. Just as depression can get in the way of recovery, emotional support from friends or family can make recovery easier.

Your anger can be killing you, say researchers who have studied the relation between cardiac risk and feelings of hostility. A study by Swedish scientists, for instance, found that both social isolation and suppressed anger impair the heart's ability to vary its rate in response to daily stress. In a study of nearly 13,000 participants, published in 2000 in the journal Circulation, those most prone to anger were almost three times more likely to have a heart attack than those with low anger. In a 2002 study in the Archives of Internal Medicine, hot-tempered medical students were three times more prone to premature heart disease and five times more likely to have early heart attacks than colleagues who stayed cool under stress.

The link between anger and heart disease may also be indirect, though no less real. Those who nurture feelings of distrust and resentment toward others also probably are contributing to the isolation that makes their recovery difficult.

By Tom Gray
© 2001 Lifescape

So your doctor has just given you the bad news: You're a heart patient, you're fighting a life-threatening disease and your life is going to change. What's the first thing you should do? Listen carefully and do what the doctor says. Also listen to nurses and other experts who will tell you how to help yourself recover.

Actually doing what they say, though, requires motivation and emotional support. It may not be easy to change all those behaviors that helped make you sick and now stand in the way of getting better. You'll need discipline to stay with the treatment, and you'll need the help of others. Your task will be far more difficult if you're depressed, angry or lonely.

So be prepared to deal with the emotional as well as physical threats to your health. Experts advise you to:

• Avoid isolation. Newly diagnosed heart disease patients commonly sink into self-absorption. They mull over their physical condition, worry about the future and may even ignore the needs of others. They need to reach out instead. If you’ve just been told you have heart disease, join a cardiac rehabilitation program, either on your own or by referral from your physician. Consider group therapy. Share your feelings with family and friends to build greater intimacy. If you're active in a church or community group, stay active. If you lack such a social network, consider joining one. If your job is just too stressful for you to go back, consider taking on a different job or a new line of work as your recovery proceeds.

• Watch for signs of depression. It's natural to feel down after learning you have heart disease. It's also natural to feel helpless after a stay in the hospital. But a persistent mood of sadness may signal a more serious condition—clinical depression. This illness is treatable. Left untreated, it can sharply lower your chances of recovery. One key symptom is a case of the "blues" that you can't seem to shake. Others include irritability, disturbances in sleeping and eating patterns (such as insomnia), feelings of worthlessness and helplessness, decreased energy and loss of interest or pleasure in ordinary activities, including sex.

Source: Wayne Sotile, PhD, Herbert N. Budnick, PhD, National Institute of Mental Health (www.nimh, nih.gov)

By Tom Gray
© 2000 Lifescape

Unless you're completely free of anger, worry, deadlines and all other sources of tension in everyday life—and who is?—you're going to feel some stress now and then. Is this bad for your heart? The research isn't clear on that. One study by Canadian scientists showed that highly stressed heart patients did not respond as well as others to medication for angina and chest pain. And the American Heart Association (AHA) says patients with heart failure should take steps to reduce and manage stress to reduce strain on their hearts.

Does stress actually cause heart disease? The scientific jury is still out on that question. The AHA does not list stress as a major risk factor in coronary heart disease. It does say that the way an individual responds to stress may be a contributing factor. It notes, for example, that people under stress may bring on known risk factors by overeating, starting to smoke or smoke more than they otherwise would. The key is to cope with stress in healthy ways and to avoid situations that make it worse.

For instance, everyone who does much driving gets cut off in traffic now and then, getting a burst of adrenaline produced by fear or anger. Some people can quickly relax and return to a normal physical state. Others stew about the incident. They might make things even worse by discussing it with others who share that hostility, and who may feed it with stories of their own.

In heart failure, the heart muscle is weakened and the patient needs to take care not to make it work any harder than necessary. So here it's important to reduce physical symptoms of stress—a pounding heart and heavy breathing—as much as possible. Though avoiding all stress may be impossible, you may be able to adjust your activities to avoid stress triggers like rush-hour traffic or long hours at work.

Support groups are recommended for coping with all the emotional factors in heart disease, from stress to anger and anxiety. One of the largest and best known is Mended Hearts (www.mendedhearts.org), which has hundreds of chapters nationwide and thousands of volunteers available to visit new heart patients.

By Tom Gray
© 2000 Lifescape

When you hear someone described as "a heart attack about to happen," chances are that he fits the personality profile we've come to call "Type A." He (typically, the subject is male) is hard-driving, a workaholic, tense, impatient, controlling and aggressive. We contrast him with "Type B," a much mellower fellow, who's serene, relaxed and amiable.

These labels made their way into our language by way of Meyer Friedman and Roy Rosenman, medical researchers who first developed them some four decades ago in the course of their research. In the years since, they've been tested and refined. Recently, for instance, researchers at the Boston Veterans Administration Medical Center found that men and women with a dominant (or “pushy”) personality type had a sharp blood pressure reactions that may relate to cardiovascular disease. But experts say not all the "Type A" traits may be linked to disease risk.

You can be highly competitive and driven to succeed, for instance, and lead a heart-healthy life as long as you know how to relax and get enough exercise. By the same token, a workaholic in a sedentary job may be losing out on necessary physical activity. And if you're blessed (or cursed) with an aggressive personality, you can find ways to work off that energy harmlessly—exercise, again, helps. Or you can get into confrontations with friends, family and co-workers, driving them away and fueling your own hostility. In that case, you're doing two things that research shows to be unhealthy—isolating yourself from intimate relationships and nurturing anger.

So what you do with your personality is up to you (and that rule applies to both men and women). "Type A" traits aren't a death sentence, though they may take some management.

Then there's type D, a new label for patients prone to emotional distress. One Belgian study found that heart attack patients who have a lot of negative emotions and tend to keep them bottled up have a greater chance of a second heart attack than those with a more cheerful disposition. These people may have no obvious Type A traits, but they could be putting their bodies under stress just the same.

By Tom Gray
© 2000 Lifescape

To win against heart disease, you'll need to fight a two-front war. On one front—the physical—your mission is obvious. You need to follow your physician's orders, take medication as directed, eat right and exercise appropriately. In other words, be a conscientious patient.

You may not be so sure about how to deal with the psychological side of the illness. Do you need professional help? Or is self-treatment, with the help of family and friends, enough?

You may get your answer when a physician or nurse refers you to a mental health professional after seeing that your emotional burdens are more than you or your loved ones can handle. Or you may come to that realization yourself—after noticing signs of depression, for instance, that you just can't shake.

If you think you do need help, don't let the stigma of mental illness stop you from getting it. Depression, hostility and social isolation are dangerous conditions for a heart patient. Unless these conditions are addressed, they can lead to a worsening of your heart disease.

Mental health professionals may also help patients understand and change behavior, such as Type-A tension and anger, that contributes to heart disease. Evidence is building that stress management programs help prevent second heart attacks. A study published in the American Journal of Cardiology in 2002 showed that a group of heart patients in a four-month weekly stress management program had fewer “cardiac events” over a five-year period than a group getting ordinary cardiac care and a group that  took a four-month exercise program.

You may not need help from mental health professionals, but if you do need it, you should never be afraid to ask for it. Heart disease is not something you should try to conquer alone.

By Tom Gray
© 2000 Lifescape