Psychocardiology: the spectrum of stress in the genesis of heart disease: a point of view

Abstract

Psychiatric disease, particularly depression and stress disorders, worsens the outcome of cardiovascular disease by about a factor of two to three. Conversely, heart disease can also cause or aggravate affective disorders in the person concerned. Although this mind–heart interaction has been known since the 1930s, many questions about the underlying mutual pathophysiology remain. Apart from psychological stress models, inflammatory or psychoimmunology processes and metabolic or endocrinological mechanisms may be involved, as might lifestyle and drug treatments. Takotsubo, or broken-heart cardiomyopathy, which frequently occurs in response to stressful events, and post-myocardial infarction depression may serve as paradigms in seeking to understand the pathological basis of the mind–heart relationship.