A study says that exhaustion is related to life-threatening irregular heartbeats

Many people living with AFib suffer chest pain, palpitations, shortness of breath and fatigue. But for others, AFib is without symptoms, a potentially silent killer.

Now, a new study published Monday in the European Journal of Preventive Cardiology suggests that chronic stress and exhaustion could be a key factor in the development of the disease.

“We have known that stress can cause other types of heart disease, but this is the first study that really links exhaustion with a potential increased risk of heart arrhythmia,” said study author Dr. Parveen Garg, professor Clinical Medicine Associate at the Keck School of Medicine at the University of Southern California.

“We know some major risk factors that are very important, such as obesity, high blood pressure and smoking, but it doesn’t explain everything about why we have this condition,” Garg said. “We are establishing a link between exhaustion and atrial fibrillation that has not really been described before.”

Stress and a silent killer

According to the American Institute of Stress, 80% of American workers say they feel stress at work; Half say they need help managing stress. In the United Kingdom, almost 600,000 people said they suffered stress during 2018 while working.

But experts say it’s more than work. It is the 24-hour news cycle, the constant connection to social networks and a career to be the best at what you do both at home and at work.

“Exhaustion can be any kind of stressful, it doesn’t necessarily have to be work,” Garg said. “It can be personal stress, tension in the home or family. It is anyone who is chronically stressed and who suffers from chronic exhaustion.”

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Previous research has shown a strong link between anger, anxiety, depression, exhaustion and many chronic diseases, including coronary heart disease and heart failure.
But when it comes to AFib, the results of the study have been mixed. Some studies have shown a link between atrial fibrillation and anger or posttraumatic stress syndrome. Others suggest that depression and other psychosocial impacts are the result of having the condition, rather than a cause of atrial fibrillation.

“It is increasingly recognized that symptoms such as fatigue and exhaustion are important from a medical perspective. We do not always know the cause, but people with fatigue and exhaustion have altered physiology,” said Dr. John Rumsfeld, director of innovation and science of American College of Cardiology, which was not involved in the study.

“For example, they may have higher heart rates and a high ‘stress response’.” Symptoms like this are clearly not healthy. But the challenge is to discover the cause and then intervene to improve them, “Rumsfeld said.

A long term study

Garg and his team followed almost 12,000 men and women who did not have AFib for a period of 25 years. Participants were evaluated on five separate occasions on psychosocial measures of anger, exhaustion, social support and use of antidepressants. These results were compared with the number of people who developed atrial fibrillation during that period of time.

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No association was found between anger levels, social support or antidepressant use once the analysis was completed. Only people who obtained the highest scores on “vital exhaustion”, a medical term for irritability, extreme fatigue and a feeling of demoralization, were more likely to develop atrial fibrillation. Why would the two be connected?

“Life depletion is associated with greater inflammation and greater activation of the physiological response to body stress,” Garg said. “When these two things are activated chronically, they can have serious and damaging effects on heart tissue, which could lead to the development of this arrhythmia.”

It’s an interesting but unproven relationship, said Rumsfeld.

“The current study is a preliminary ‘first step’ assessment of a potential relationship between exhaustion and atrial fibrillation,” Rumsfeld said. “It is purely an observational study: it cannot conclude a causal relationship, even in what direction that relationship would go.

“We need more research on this,” he continued. “Symptoms such as fatigue and exhaustion are extremely common. Certainly in people who have medical conditions, but also in those who don’t … and the question is whether these symptoms can predispose to medical conditions such as atrial fibrillation.”

Garg agrees. “We are by no means saying that if you can reduce your levels of exhaustion, you will reduce your risk of developing atrial fibrillation,” he said. “That is an intervention study that we have not done.

“But I think the main message to take home is that high levels of stress, high levels of exhaustion can have an impact on your heart and mind.”

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