One of my patients introduced me as, "This is Dr. Azimi, his patients are literally dying to see him." And I got the joke because I work at the busiest heart attack hospital in California. And I meet people often for the first time when they're there with their first heart attack. And when we talk about heart attacks, we worry about the risk factors of what leads to a heart attack. We often talk about age, gender, high blood pressure, high cholesterol, diabetes, smoking. But one of the things we underestimate is the influence of adrenaline and stress. Type A personality has been associated with increased risk of heart attacks. These patients that are under extreme stress can have symptoms that are actually representative of a heart attack and have what we call broken heart syndrome, such that their heart and their EKG and their blood tests look like they're having a heart attack, but there is no actual clot or blockage in any of the arteries. So the role of stress and anxiety is great in terms of its contribution to heart disease, both in the short term when it's extreme and causes broken heart syndrome, but in the long term, because it raises adrenaline levels and affects increased heart rate, increased blood pressure and potentially increased oxidative damage and plaque.
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