“Let your heart rule your head” might just seem like a phrase about letting your emotions help you make a decision, but it turns out there’s a very real medical connection between our hearts and our heads.
We’ve long known of the connection between heart health and a variety of associated and sometimes causative factors. In fact, I’ve often focused this column on managing these risks. We’re now learning about how interconnected the body’s systems are, and how different organs may be affected by the same factors, even when the connection seems hard to trace. For example, we’ve learned that oral health can influence your circulatory system, and obesity worsens arthritis. Now we have additional data supporting the connection between the heart and the head.
In fact, heart health and mental health seem to be associated with one another and conversely, problems with one certainly can influence the other. Research suggests that people with depression are more vulnerable to heart disease, and people with lasting concerns from heart problems are prone to some types of mental illness.
The combination of mental illness and heart disease can also affect your lifespan. A recent survey has shown that people diagnosed with both bipolar disorder and heart disease die more than a decade sooner than those heart patients without a mental illness.
Depression and heart disease
Depression, the most common mental illness, typically presents symptoms such as persistent sadness and feelings of emptiness, irritability, fatigue, restlessness and pain that has no obvious medical cause.
Traditional research suggests that depression is caused by unbalanced neurotransmitters in the brain, but recent evidence also implicates ongoing inflammation in the body as a trigger for depression symptoms. Now remember, we know that inflammation is a key instigator in heart and vascular disease.
It seems that as depression and its psychological symptoms worsen, so do the ravages of heart disease.
Knowledge of this relationship is not new. In fact, when the Pearsall Heart Hospital first opened 17 years ago, a local psychologist did her internship with us, exploring the intense influence of a new diagnosis of heart disease on depression symptoms in our patients. Nice job, Kim!
AFib and dementia
Atrial fibrillation (AFib) and dementia are also linked, but not for the reason you might expect.
AFib is an irregular heartbeat that increases your risk of heart attack and stroke. It has been well established that the blood clots caused by AFib cause strokes and occasionally heart attacks, and the brain damage that results can have devastating effects on brain function, including speech, movement, thinking and emotion. New research indicates that the irregular heartbeat itself can accelerate mental decline, even without an actual stroke affecting the brain’s structure.
When you have AFib, blood doesn’t flow normally and overall circulatory function deteriorates, which may alter the amount of oxygen and glucose reaching your brain. In addition, you are more susceptible to mini-strokes that won’t appear in most stroke screening studies.
The trouble with treatment
Treatment for those with both mental-health and heart-health problems can be tricky.
Certain heart medications have emotional side effects, while some drugs that treat mental health are known to have their own list of heart-damaging side effects. Plus, the stresses of medical and surgical procedures for the heart can cause anxiety even in those without a history of pre-existing mental illness.
However, newer treatments and a renewed focus on lifestyle improvements are helping minimize these confounding effects. The American Heart Association and American Psychiatric Association have both recommended depression screenings for heart patients, while interdisciplinary care teams focus on choosing the most effective treatments that don’t worsen existing conditions. Nutrition coaching and physical therapy can also reduce the behavioral risk factors for heart disease, improving quality of life.
Hormones that circulate messages from one organ to the whole body, nutrients that flow to all parts of the body through our common bloodstream, a nervous system that connects our one brain to cells throughout our body and now, our immune system and its reaction to inflammation — all these and more cross-system connections that we’re just learning about are the ways seemingly unrelated parts of our body are actually closely inter-dependent, confirming that Paul Simon was not describing physiology when he wrote “I am a rock; I am an island.”
Dr. Alfred Casale, a cardiothoracic surgeon, is Associate Chief Medical Officer for Geisinger Health and Chair of the Geisinger Cardiac Institute. Readers may write to him via [email protected]