Stress and atrial fibrillation (AF): Recognizing the link and protecting your heart

What is atrial fibrillation (AF)?

Atrial fibrillation (AF), also known as atrial flutter, is the most common type of irregular heart rhythm (arrhythmia). It is characterized by a disorganized and very rapid electrical activity in the atria of the heart, causing them to beat irregularly and often too fast. In medical terms, “fibrillation” refers to rapid, uncoordinated contractions of muscle fibres, particularly those of the heart.

Under normal conditions, the atria contract in a regular manner to push blood into the ventricles. However, during atrial fibrillation, these contractions become uncoordinated and ineffective, reducing the heart’s efficiency, lowering blood flow, and increasing the risk of complications such as heart failure and stroke due to blood clot formation in the atria.

What are the symptoms of AF?

The most common symptoms of atrial fibrillation include:

• Palpitations (a racing or irregular heartbeat)
• Shortness of breath
• Extreme fatigue
• Exercise intolerance
• Dizziness or fainting episodes (in some cases)

The severity of symptoms varies depending on heart rate and the duration of AF episodes.

Who is at risk for AF?

Atrial fibrillation can occur sporadically, often before the age of 60, or become persistent or even permanent as one gets older. The risk of developing AF increases significantly with age.

Several factors contribute to the development of atrial fibrillation, including:

• High blood pressure (hypertension)
• Heart diseases (such as coronary artery disease, history of heart attack, and valve abnormalities)
• Obesity and diabetes
• Sleep apnoea
• Hyperthyroidism

Certain lifestyle habits also increase the risk, including:

• Smoking and excessive alcohol consumption
• Endurance sports participation (such as marathon running)
• Respiratory illnesses (such as pneumonia or pulmonary embolism)

How is AF diagnosed and treated?

Atrial fibrillation is diagnosed using an electrocardiogram (ECG), which detects irregular heart rhythms.

Treatment aims to regulate the heart rate using antiarrhythmic medications or cardioversion (a procedure that restores normal heart rhythm). To prevent blood clots and reduce stroke risk, anticoagulants are often prescribed. In cases where medications or cardioversion fail, radiofrequency ablation, which is a surgical procedure that destroys the abnormal heart tissue causing the irregular signals, may be recommended.

While atrial fibrillation can sometimes be benign, its complications can be severe. Managing risk factors and underlying causes is essential. Notably, stress is believed to play a major role in triggering or worsening AF episodes.

Why are some people more sensitive to stress?

People respond differently to stress due to various factors, including:

• Genetics: Some people have a more reactive nervous system, making them more sensitive to stress.
• Life experiences: Past stressful events can make a person more vulnerable.
• Overall health: Chronic illnesses, fatigue, or lack of sleep increase stress susceptibility.
• Hormonal differences: Women, for example, tend to be more sensitive to stress due to hormonal fluctuations.
• Socioeconomic conditions: Financial instability and social stressors contribute to chronic stress and unhealthy coping behaviours.

Stress sensitivity is influenced by biological, psychological, and social factors and can impact both mental and physical health—including heart health.

What role does stress play in atrial fibrillation (AF)?

Stress is a known contributor to both the onset and worsening of atrial fibrillation. While research is ongoing, existing studies suggest that stress, whether acute or chronic, affects heart rhythm regulation.

Acute stress and AF

Strong emotions such as fear, anger, or sadness can trigger AF episodes by stimulating the nervous system, which regulates heart rate. Studies have shown that negative emotions significantly increase the risk of AF, while positive emotions (such as joy) may help lower the risk.

Chronic stress and AF

Prolonged stress can also impact AF by disrupting the autonomic nervous system. This effect appears to be more pronounced in men, although women and younger people with depression are also at an increased risk of AF.

Interestingly, relaxation techniques such as yoga have been found to reduce AF frequency and improve quality of life in affected individuals. Additionally, there is a well-established link between depression and AF, people with a history of depression are more likely to develop this arrhythmia.

Furthermore, atrial fibrillation itself induces stress and anxiety in approximately 35% of patients, creating a vicious cycle where stress triggers AF, and AF, in turn, increases stress and anxiety. Proper medical management and stress reduction strategies are crucial in breaking this cycle.

In summary, both acute and chronic stress disrupt heart function and promote AF episodes. At the same time, the presence of AF can heighten stress, creating an ongoing loop that negatively affects both cardiac and mental health.

How can you manage stress and protect your heart?

To manage stress and safeguard your heart, adopting healthy lifestyle habits and relaxation techniques is essential.

Adopt a heart-healthy lifestyle

• Exercise regularly: Engage in moderate activities like walking or cycling for at least 30 minutes per day to reduce stress and improve cardiovascular health.
• Eat a balanced diet: Consume nutrient-rich foods that combat stress, such as oats, berries, salmon, leafy greens, and nuts. Limit caffeine, sugar, and alcohol, as these can increase anxiety.
• Get quality sleep: Aim for 7 to 8 hours of sleep per night to reduce stress and support heart health.
• Avoid alcohol and smoking: These substances worsen stress and increase heart disease risk.

Practice relaxation techniques

• Try yoga, meditation, or deep breathing exercises: These practices effectively lower stress levels and regulate heart rhythm.
• Avoid self-medication: Consult a doctor before using herbal supplements, as some may interfere with heart medications.

Take a proactive approach

• Educate yourself about AF: Understanding your condition can help ease anxiety and improve disease management.
• Seek medical support: If stress becomes overwhelming, consider therapy or counselling to help manage anxiety.

Reduce daily stressors

• Organize your time to avoid feeling overwhelmed.
• Limit screen time, especially before bed, to improve sleep quality.
• Practice emotional regulation to prevent overreacting to stressful situations.
• Engage in hobbies and social activities to boost relaxation and reduce isolation.

Key takeaways

Stress, whether acute or chronic, can worsen atrial fibrillation by disrupting heart rhythm. AF itself can increase stress, creating a vicious cycle that affects both heart and mental health. Managing stress through lifestyle changes, relaxation techniques, and proper medical care is essential for heart health.

If you experience increased AF episodes due to stress, consult a cardiologist. They can adjust your treatment plan and suggest effective stress management strategies, including psychological support or relaxation techniques.

⚠️ Seek urgent medical attention if you experience:

• Frequent or prolonged palpitations
• Severe shortness of breath
• Chest pain

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