In a large international study, researchers found an association (more than twice the risk) between anger or emotional upset and the onset of heart attack symptoms within one hour. The same was true for heavy physical exertion during the hour before their first heart attack.

However, the association was stronger (more than triple the risk) in those patients who recalled being angry or emotionally upset while also engaging in heavy physical exertion.

"Previous studies have explored these heart attack triggers; however, they had fewer participants or were completed in one country, and data are limited from many parts of the world," said study lead author and a researcher. "This is the first study to represent so many regions of the world, including the majority of the world's major ethnic groups."

Researchers analyzed data from 12,461 patients (average age 58) participating in INTERHEART, a study consisting of patients with first-ever heart attacks across 52 countries. Participants completed a questionnaire about whether they experienced any of the triggers in the hour before their heart attack. They were also asked if they had experienced any of the triggers in the same one hour period on the day before their heart attack.

Authors said that these triggers appeared to independently increase a person's heart attack risk beyond that posed by other risk factors, including age, smoking, obesity, high blood pressure and other health problems.

Author said that extreme emotional and physical triggers are thought to have similar effects on the body.

"Both can raise blood pressure and heart rate, changing the flow of blood through blood vessels and reducing blood supply to the heart" author said. "This is particularly important in blood vessels already narrowed by plaque, which could block the flow of blood leading to a heart attack."

"Regular physical activity has many health benefits, including the prevention of heart disease, so we want that to continue," author said. "However, we would recommend that a person who is angry or upset who wants to exercise to blow off steam not go beyond their normal routine to extremes of activity."

One limitation of the study was that participants had to recall their triggers. After a heart attack, a person may be more inclined to say they experienced a trigger than they otherwise would be. In addition, participants were not given any descriptions of being angry or emotionally upset or of heavy physical exertion. Self-defined, these triggers appear to have the same effect across countries and ethnicities.

http://newsroom.heart.org/news/emotional-upset-and-heavy-exertion-may-trigger-a-heart-attack