• Chronic stress is a risk factor for heart disease and it may lead to a heart attack.
• Stress can cause high blood pressure, increase heart rate, and lead to overeating, smoking cigarettes, and drinking more alcohol — all of which are major risk factors for a heart attack.
• Sudden stress can also cause a cardiac event that feels like a heart attack, called takotsubo cardiomyopathy or "broken heart syndrome."
• This article was reviewed by Steven Reisman, MD, a cardiologist and the director of the New York Cardiac Diagnostic Center.

While stress can't directly cause a heart attack, it can have a major impact on your heart health, and even trigger an event that feels just like a heart attack.

Here's what you need to know about the effects of chronic stress on your heart, as well as a rare condition called stress-induced cardiomyopathy.

Chronic stress is a risk factor for heart disease

Chronic stress can lead to high blood pressure, or hypertension, which is a major risk factor for a heart attack. According to a 2010 study in Current Hypertension Reports, chronic stress — including that from racial biases, poverty, or relationship troubles — contributes to the development of hypertension. About 70% of people having their first heart attack will have hypertension.

Stress also raises your heart rate. Over time, a prolonged state of stress can have a negative impact on your heart. For example, anxiety is associated with a higher risk of many types of heart disease: coronary artery disease, heart failure, and heart rhythm disorders like tachycardia.

In addition, stress can enable unhealthy habits as people try to cope. These often include smoking cigarettes, drinking more alcohol, and overeating — all of which can negatively affect your heart and increase your risk for a heart attack.

Sudden stress can cause "broken heart syndrome," which feels like a heart attack

One of the most dramatic ways stress can affect your heart is by causing takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy or "broken heart syndrome."

This feels just like a heart attack, with symptoms including chest pain and shortness of breath, but it is a different condition altogether, says Lauren Gilstrap, MD, a cardiologist at Dartmouth Hitchcock Medical Center.

Those symptoms come on suddenly, triggered by a stressful emotional event, such as the sudden death of a loved one. "Its presentation isn't subtle," Gilstrap says. "People think they're having a heart attack."

However, that's not the case. A heart attack occurs when an artery to the heart is blocked. Takotsubo cardiomyopathy has no underlying blockages. Its exact causes aren't known, but are thought to be tied to a sudden hormonal surge from the body's fight or flight response.

"Takotsubo cardiomyopathy is a fundamentally different phenomenon than a heart attack," Gilstrap says. "The arteries are completely fine and the blood supply is completely normal, but all of a sudden, the heart doesn't squeeze."

That means, suddenly, not enough blood is being pumped throughout the body, which is considered acute heart failure. Although the condition comes on suddenly, your heart may not pump efficiently for two to four weeks, though most patients will return to normal heart function within two months. Most patients with takotsubo cardiomyopathy will be treated with a heart failure protocol, including beta-blockers and other medications, Gilstrap says.

Takotsubo cardiomyopathy is most common in women aged 58 to 75, who make up more than 90% of cases. Doctors aren't entirely sure why, but one study found that women experience higher rates of emotional stress. About 5% of women who think they're having a heart attack are actually experiencing stress-induced cardiomyopathy.

Still, true heart attacks are more common than takotsubo cardiomyopathy: only about 2% of people presenting at hospitals for symptoms of heart attack actually have takotsubo cardiomyopathy.

How to manage stress and reduce your heart attack risk

Reducing and managing stress through mindfulness, exercise, and hobbies is an important part of overall health, and it may improve cardiac health.

However, making lifestyle changes to reduce stress is extremely difficult for people. Because of that, Gilstrap recommends her patients take a realistic look at the stressors in their lives and adjust what they can, without worrying too much about what's out of their control.

"Life is complicated and people have demands from a variety of places," Gilstrap says. "It's about fixing the ones that can be fixed, building on that success, and empowering the patient to make even more positive change in that direction."

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• How to prevent a heart attack the first time and from happening again
• What is a silent heart attack? How to recognize the warning signs
• What are the signs of a heart attack? How to know if you're at risk
• How hypertension, heart disease, and stroke are related
• How to lower blood pressure with a heart-healthy diet and exercise
• What to do if you're having a heart attack after calling 911