Taking Things TO HEART

By Jonathan Fisher, MD FACC

What does our emotional state have to do with the physical health of the heart? Cardiologist Jonathan Fisher explains the links between thoughts, emotions, and cardiovascular wellness, and how the skills of emotional intelligence can help you take good care of your heart.

For millennia the heart has been portrayed as the seat of our emotions. While this imagery has been popularized in art and literature, modern neuroscience and cardiovascular research have only recently begun to explore the connection between human emotions and physical health.

Over time, our hearts are literally shaped by our emotions and moods. Just as we now know we can rewire our brain’s connections using specific practices (a process known as neuroplasticity), the structure and function of the heart may undergo changes in response to our emotions: one form of a process known as cardiac plasticity.

Balanced Mind, Strong Heart

Difficult emotions are shown to risk harming the physical heart. For example, a 2014 meta-analysis of 30 prospective studies (40 independent reports), with 893,850 participants and follow-ups ranging from 2 to 37 years, found that depression predicted the excess risk of developing coronary heart disease or heart attack. Anxiety, traumatic events, anger, frustration, and unrelenting job stress all pose similar cardiovascular risks, and likely share a common physiologic pathway.

The most extreme example of negative emotions impacting heart health is a condition known as stress cardiomyopathy, commonly referred to as “broken heart syndrome.” In this condition, the physical heart weakens and sometimes fails as a result of extreme grief, emotional distress, or surprise. The risk of heart attack increases 21-fold within 24 hours after the loss of a loved one.

Conversely, research has shown that positive prosocial emotions like gratitude, optimism, and empathy can have the opposite result, reducing stress and helping the heart enter a state of balance and calm. Optimism, life purpose, and positive affect have been linked with reduced risk of developing coronary heart disease (CHD). In one large trial, 97,253 healthy women were followed for over eight years. Optimists were found to have a lower risk of CHD, including 30% lower CHD mortality, and 14% lower total mortality. Those with higher levels of cynicism and hostility were found to have a higher risk of early death, either from cancer or other causes.

A Change of Heart

In order to understand how emotions impact our bodies, it’s important to know where they come from.

Many of the factors of stress reactivity begin in the mind. It is our perception and interpretation of events and our experiences—the meaning we make consciously or subconsciously—that determines our thoughts, feelings, and behaviors.

There are three overlapping mechanistic pathways, found in our mind, body, and behavior, linking stressful emotions, psychological well-being, and cardiovascular health. Let’s take a brief ride along the mindheart highway.

First let’s look at where emotions come from, then we can unpack the difference between feelings, emotions, and moods.

Damasio, chair in neuroscience, as well as professor of psychology, philosophy, and neurology, at the University of Southern California. According to Damasio, feelings are the meaning we give our emotions based on our memories and beliefs, and the subjective labeling of our experiences. For example, if we are called on to speak in public, we might experience emotional responses such as a faster heartbeat, tense muscles, and a sensation of butterflies in the stomach. These physical sensations are then interpreted by our conscious mind, which labels them as a feeling: “fear.”

ABOUT THE AUTHOR

Dr. Jonathan Fisher, MD, is a clinical cardiologist, mindfulness meditation teacher, and organizational wellbeing and resiliency leader. In 2020 he cofounded the Ending Physician Burnout Global Community and organized the world’s first global summit dedicated to ending physician burnout, with over a thousand participants from 43 countries.

While we may not be able to control some factors in heart health, such as the genes we inherit, understanding the connection between emotions and cardiovascular health allows us to cultivate the emotions that nurture both our emotional and physical heart.

Emotions—primal, unconscious bodily responses— originate in a matter of seconds from the limbic centers of the brain (e.g., the amygdala), providing information to the more modern and uniquely human prefrontal cortical centers responsible for meaning-making and planning.

Emotions then give rise to feelings. Contrary to what we might believe, emotions are different from feelings, says Antonio

Moods are the constellations of emotions and feelings that may have no connection to an initial triggering event, and can last for days or more. When we have recurring emotions and feelings and begin to identify with them—seeing an emotion as part of who we are— we may not be consciously aware of them, because they seem like constant companions instead of information that arises and passes.

How Emotions Propel Us

Our emotions help the body move toward self-protective action. Even the root of the word emotion reminds us →

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