When Stress Causes Heart Disease

Evidence suggests that, in certain people, certain types of emotional stress can increase the risk of chronic heart disease and even trigger acute cardiac crises.

Very severe episodes of emotional stress—stress that shocks—can be particularly harmful and can even precipitate acute cardiac conditions.  Examples include the death of a loved one, divorce, loss of a job, business failure, being a victim of violence, exposure to natural (or man-made) disasters, or serious conflicts within a family.

Evolutionarily speaking, emotional stress was a protective mechanism that helped keep our distant ancestors alive. When your great, great, great (etc.) grandfather walked over a rise and suddenly saw a deadly animal, a surge of adrenaline prepared him for either fight-or-flight as he considered his options.

But in modern times, neither fight-or-flight is usually an appropriate and socially correct reaction to day-to-day stress. The same adrenaline surge often accompanies stressful situations; however, instead of releasing our tension in a burst of physical exertion, we are forced to suppress it. It appears that the kind of stress that goes along with feeling boxed-in, with no control over your own choices, is a particularly debilitating variety of emotional stress.

These kinds of internalized, fight-or-flight reactions—if they occur often enough—may be harmful to your cardiovascular system. Furthermore, it appears that the harm more often occurs in individuals who have not devised healthy ways of dissipating the anger, frustration, and fear that result from emotional stresses we often encounter in modern life.

Stressed out office worker
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Is All Emotional Stress Bad?

Not all emotional stress appears to cause harm. There is such a thing as "good stress", for example when your job performance is enhanced in high-pressure situations. 

Do All People Respond the Same Way to Emotional Stress?

Needless to say, people respond differently to all kinds of stress. Evidence suggests that it may be individual response, rather than the stressor itself, that is the real issue.

People with Type A personalities (those with a tendency toward time-sensitivity, impatience, hostility, anger, a chronic sense of urgency, and competitiveness) are at a higher risk for coronary artery disease than people with Type B personalities (patient, low-key, non-competitive, and time-insensitive).

In other words, given the same stressful situation, some will respond with frustration and anger, the rush of adrenaline and the fight-or-flight mode, and some will react in a much more even-tempered way.

This is why the advice you often hear from doctors to “avoid stress” is so impractical. Nobody can avoid all stress without completely dropping out of society and becoming a monk. Besides, people of the Type A persuasion will create their own stressful situations no matter where they are or what they're doing.

A simple trip to the grocery store could become an ordeal of bad drivers, poorly-timed traffic lights, crowded aisles, indifferent checkout clerks, and grocery bags that rip too easily. Unfortunately, if you have this sort of mindset, then retiring, changing jobs, or moving to Florida is not likely to significantly reduce your stress levels.

Reducing stress levels for these individuals, then, requires not the (impossible) complete elimination of all stressful situations, but a change in the way stress is perceived and handled. In other words, Type A personalities can benefit from learning strategies to become more B-like.


The way stress is handled is key to a healthy mindset. While emotional stress is related to heart disease, not all emotional stress can be avoided, and not all of it is "bad." How you respond to the stress is extremely important in determining how much risk the stress you experience every day imposes on your heart.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Wirtz PH, von Känel R. Psychological stress, inflammation, and coronary heart disease. Current Cardiology Reports. 2017;19(11):111. Published September, 2017.

  2. Stewart RAH, et al. Persistent psychological distress and mortality in patients with stable coronary artery disease. Heart. 2017 Dec;103(23):1860-1866. doi:10.1136/heartjnl-2016-311097.

  3. Steca P, et al. A Type A and Type D Combined Personality Typology in Essential Hypertension and Acute Coronary Syndrome Patients: Associations with Demographic, Psychological, Clinical, and Lifestyle Indicators. PLoS One. 2016 Sep 2;11(9):e0161840. doi:10.1371/journal.pone.0161840

  4. Crum AJ, Salovey P, Achor S. Rethinking stress: the role of mindsets in determining the stress response. J Pers Soc Psychol. 2013;104(4):716-733. doi:10.1037/a0031201

  5. Jamieson JP, Nock MK, Mendes WB. Mind over matter: reappraising arousal improves cardiovascular and cognitive responses to stress. J Exp Psychol Gen. 2012;141(3):417-422. doi:10.1037/a0025719

Additional Reading
  • Pignalberi, C, Patti, G, Chimenti, C, et al. Role of different determinants of psychological distress in acute coronary syndromes. J Am Coll Cardiol 1998; 32:613.
  • Shekelle, RB, Gale, M, Ostfeld, AM, Paul, O. Hostility, risk of coronary heart disease, and mortality. Psychosom Med 1983; 45:109.

By Richard N. Fogoros, MD
Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology.