Anger management: An anger episode may trigger an acute heart attack within 2 hours

Emotionally stressful events, and more specifically, anger, immediately precede and appear to trigger the onset of acute myocardial infarction (MI) and other cardiovascular events.

Outbursts of anger increase the risk of acute myocardial infarction, acute coronary syndrome, ischemic stroke, ruptured intracranial aneurysm and ventricular arrhythmia. This was corroborated by a systematic review and meta-analysis published in the European Heart Journal, which found a higher risk of cardiovascular events in the 2h after outbursts of anger (Eur Heart J. 2014 Jun 1;35(21):1404-10).

An earlier study from Deaconess Hospital, Harvard Medical School published in the journal Circulation in 1995 had shown that episodes of anger are capable of triggering the onset of acute myocardial infarction and that that this risk may be reduced by the use of aspirin (Circulation. 1995 Oct 1;92(7):1720-5). More than 1600 patients were studied, of which 39 were found to have episodes of anger in the 2 hours before the onset of MI. The relative risk of MI in the 2 hours after an episode of anger was 2.3. This risk was mitigated by aspirin. Compared to nonusers, patients who were taking aspirin regularly had a significantly lower relative risk; 1.4 vs 2.9, respectively.

These studies caution that heart patients on aspirin should continue to take aspirin to prevent anger-induced heart attack or stroke.

The description of anger comes in mythology as one of the five vices which need to be controlled to acquire spirituality. The description of anger in mythology is as under:

• Lord Shiva is also shown wearing a snake in his neck with hood directed inwards. Shiva is also said to have a blue neck or Neelkanth indicating that to control anger one should neutrilise then anger continuously (matted hairs) with cool mind (Moon) using positive flow of thoughts (ganga) with ego controlled (naag)
• Bhagavad Gita talks about anger in great details and tells that anger is as a result of unfulfilled of desires. As per Bhagavad Gita lust leads to anger and anger leads to ego.
• As per Lord Shiva, anger can be expressive and or suppressive. Expressive anger can lead to rupture of arterial blockage and suppressive anger can lead to arterial blockage. The best answer described by Lord Shiva is to manage and control the anger.
• Two forms of Goddess Durga and Kali also indicate when to get angry.
• As per mythology, one should learn to control anger but it also talks about allowable spiritual anger when it is done for the benefit of the mankind.

The period of Uttarayana has started, which is the phase of a positive state of mind. But even then people with angry temperament, especially heart patients on aspirin should not miss their daily aspirin dose.

It is equally important to learn to manage one’s anger.

• As per Shiva Puran, anger management is described under Neelkanth role of Lord Shiva. The blue color means slow poison (one of them being anger) which is kept in the neck. It indicates that anger should not be expressed or suppressed but should be managed. Management involves continuously (Jatadhari) with cool mind (Moon), one should direct positive thoughts (Ganga) towards the reason for anger keeping the ego under control (Naag) with head directed in.
• As per Bhagwad Gita, anger is always resulting of non-fulfillment of desires. Therefore, one must act at the levels of desires.
• As per Marshal Rosenberg, indulging in non-violent communication helps in managing anger.

• Drugs like SSRI used in modern medicine, primarily focus on reducing irritability and chronic anger. They may take as long as 10 weeks to act. Aspirin is also recommended in people with un-managed anger to prevent occurrence of heart attack.

Anger recall is as bad as anger itself, which can be expressive or suppressive. Both are dangerous. Expressive anger causes plaque to rupture leading to heart attack or MI, while suppressive anger causes chronic sympathetic overactivity that helps plaque formation.  

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA