Anger Can Kill – In an Instant or Slowly and Silently

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

Anger can kill in an instant by triggering acute cardiovascular events like heart attacks and stroke. A new study, published in a 2015 issue of the American Heart Journal, shows that anger, and even an angry personality trait, can contribute to trouble by choking off oxygen to the heart muscle without any symptom of chest pain.

The study made use of sophisticated imaging (single-photon emission computed tomography) to document a direct anger link to “silent ischemia.” Ischemia refers to the heart muscle not receiving adequate oxygen to optimally conduct its demanding around-the-clock pumping action, usually a result of narrowed or blocked coronary arteries. This situation is frequently accompanied by angina (chest pain), the most common symptom of coronary artery disease.

In this study, Emory University researchers tested nearly 100 men and women between the ages of 38 and 60 – a younger population − who had survived a heart attack within the previous six months. Imaging was conducted before and after a mental stress challenge involving public speaking about a real-life stressful situation. Those participants who had higher levels of anger, either as a temporary emotion response or as a personality trait, were found to have a more significant increase in heart muscle ischemia.

This was the first study, according to the researchers, to document the association between anger dimensions and mental stress-induced silent ischemia using the most current imaging standard for ischemia assessment.

 My Viewpoint: I have treated many patients whose anger triggered heart attacks and who had no previous warnings. Let me make it clear that not everybody survives. Anger is like throwing gasoline on a fire. Stress and anger can constrict arteries or cause an arterial spasm. In “silent ischemia,” there is no previous warning, no angina, for reasons not altogether clear. Often this situation occurs among women, older individuals, and diabetics. It is usually diagnosed when an electrocardiogram (EKG) or stress test indicates the heart isn’t receiving an adequate blood supply.

 What This Means to You: Previous studies have consistently implicated acute anger as an important precipitator for angina and/or heart attacks. For individuals with a history of heart attack, as was the case in this study, anything that causes ischemia is a problem and a risk for another heart attack. The findings in this study provide more evidence that anger, either as a temporary state or as a personality trait, can indeed be hazardous for this population and people with heart conditions. And, I would add, for anybody.

 Recommendation: If you have an anger problem, you better do something about it. I also highly recommend reading, “Is It Worth Dying For?” by cardiologist and stress expert Bob Eliot. In this ever-relevant 1984 book, he advises that the best way to handle hostility, anger, and explosive rage is to understand that such emotions are fraught with danger, including the potential for sudden death. Eliot’s mantra was: “don’t sweat the small stuff….it’s all small stuff anyway.”


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