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Comment by Zazezizozuzy | Hacker News Reader

I would be interested in knowing what 'hard on the heart' means. They mention it can lead to cardiovascular disease, but I understand that to be kind of a vague term.

I am a fairly healthy young guy and I have extremely high blood pressure. Every doctor I've seen has been unable to identify a cause through testing, dietary changes, fluctuation of exercise, etc. When I was younger, I was diagnosed with Bipolar Disorder and have had major bouts of depression my whole life. More so since getting a job as a developer. Any data connecting the depression and HBP would be really helpful.

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I don't have a medical explanation for you, but I can tell you what it feels like. I've experienced many pangs of deep loneliness at times when I feel like I'm by myself and should be out being social. It feels like a tug on your chest. Like there's a void and some gravity is sucking things down into it. Or, I know it sounds corny, but something heavy sitting on your heart while you simultaneously experience anxiety.

When I am deeply lonely like this, in the moment, not just as a general idea, I definitely do feel it as a physical thing. I don't know if it's the same as what they're talking about here, but it seems reasonable that loneliness could be a type of depression, and I strongly believe that regularly experiencing the type of physical feeling described above could do damage to you.

Thanks for describing this and I really hope this improves for you over time. I had years of feeling like this too . I can't say I've really found my place but at 50, memories of that depression are from another life. I can't really rightly remember what it felt like, but it was terrible.

I have had this feeling in my chest for over a decade now.

Do you continue to have the feeling despite attempts to go out and be social?

Yes, this feeling is relatively constant in my life. There are times where it is more noticeable though. Usually getting lost in the moment is the best way, but that is hard to do on purpose

I don't know if I can relate. When it really bothers me, I try to do something about it, go out, have fun. Surround myself with people whose company I enjoy.

Sometimes the feeling persists. Its usually when I try the above and fail though. When its not satisfying, when the people I'm with are just kinda whatever. -shrugs-

The paper states that depressed mood and exhaustion are a risk predictor for all-cause cardiovascular mortality comparable to hypercholesterolemia and obesity. Essentially this means that a person with clinical depression is about as likely to die from cardiovascular disease (main specific causes of death being being heart attack and stroke) as a person with high cholesterol or who is overweight, and all of which are more likely to die of CVD than someone with none of the above.

This study is purely correlative. They do not hypothesize or investigate the pathophysiology by which depression can lead to these problems. I'm sure there is some research in this area, but in my medical education I have not come across any specific examples. To my knowledge there is no consensus that depression directly causes hypertension.

I can tell you from clinical experience that people with depression generally do not take good care of themselves (and this is not a judgment, just an observation). Their diet is poor, they do not exercise regularly, and are non-compliant with medical therapies. In other words, their lifestyle leaves them vulnerable to a whole host of diseases. However, I would still argue that the biggest risk factors for essential hypertension are family history and race, not behavior or mental health.

Well, for what this anecdote is worth: I was bullied bullied growing up, and I had tachycardia[0]. Both stopped around the time I went to college. I can count the number of times I've had it since on one hand (before it was multiple times per week), and it was always during periods I was suffering from extremely high socially induced stress. Severe heartbreak, the loss of someone very close to me, things like that. Since I've picked up mindfulness and become a more balanced, calm person I've not had it at all.

I know that there are many diseases one can have growing up that might just "go away" when you get older, and we usually blame it on hormonal imbalances, and your body growing up and figuring things out. I wonder we're underestimating how the many anxieties that teenagers suffer from might cause or amplify these issues.

[0] Since you're in the medical profession, I'm sure you know what tachycardia is, but for others: it's when the heart rhythm becomes so fast that the heart muscles can't keep up, and are no longer pumping blood properly. Luckily my form of tachycardia is regular and fairly harmless on its own. Anyway, in my case it would trigger when startled, usually when I was doing some kind of "inconsistent" physical exertion (by which I mean that it never happened when running or cycling, even if I pushed myself to my physical limit). So it seems to require a mix of social and physical stress, plus something unexpected happening (I guess the adrenaline triggers it?)

Tachycardia is technically any heart rate greater than 100 BPM. It doesn't necessarily mean that the heart is not pumping enough. What can happen with an elevated heart rate is that the heart doesn't have enough time between beats to fill properly, resulting in decreased stroke volume and cardiac output, but this is typically only seen clinically with certain dysrythmias that have very high rates (like in the 150-200 rage), or in the setting of cardiomyopathies (diseases of the heart muscle), MI (heart attack), or heart failure. If your heart muscle tissue was actually not able to keep up, it would mean you had one of these things, which you most likely didn't.

What you are describing sounds like textbook palpitations. It is completely normal for the heart rate to increase for a lot of reasons, including stress and being startled (via the sympathetic nervous system, or fight-or-flight response). A palpitation is when a person becomes very aware of their heartbeat and perceives it to be abnormal, regardless of whether there is any clinically objective abnormality. They are often associated with anxiety and can lead to a vicious cycle (person is anxious, then notices their heart is beating fast, so they become more anxious, their heart rate increases, etc.).

The silver lining here is that in all likelihood your heart was/is fine. Anxiety has also been proposed as a risk factor for CVD but my understanding is that this is still debated. So don't go thinking your history means you'll definitely have an MI.

None of this is meant to dismiss your experience though. Not three days ago I saw a young, healthy male in the ED who thought he was having a heart attack, and (you guessed it) his EKG and labs were 100% normal. It probably happens a lot more than people realize.

By the way, I'm not saying "don't go to the doctor because that 'heart attack' is all in your head". He absolutely made the right decision by coming in (better safe than sorry).

You forgot to account for one case, which is what applies to me: my heart rate "jumps" from 160, during peak physical exertion, to 230+ BPM, when I get this tachycardia, and then "jumps" back after a while if I sit down to relax. At that rate the heart doesn't have enough time to contract fully, like you said.

I got prescribed verapamil, and there's also this trick of trying to breathe out with mouth and nose closed, to use the lungs to put pressure on the heart. This can trigger some kind reflex (I forgot the name) that slows down the heart rate.

> The silver lining here is that in all likelihood your heart was/is fine. Anxiety has also been proposed as a risk factor for CVD but my understanding is that this is still debated. So don't go thinking your history means you'll definitely have an MI.

From what the cardiologist told me the 230 BPM is abnormal, but OTOH, my heart rate maintains a regular rhythm, so it's fairly harmless, and I'm likely not in any high risk group.

Preface: I'm not trying to nitpick you to death. I wouldn't expect anyone outside the medical field to remember any of these terms.

Yes, a HR of 230 BPM is not normal. The terminology is confusing because tachycardia can be both physiologic ('normal') and pathological ('abnormal') depending on the context. What you are describing is not "just" tachycardia, but most likely a type of supraventricular tachycardia/tachyarrhythmia (not a cardiologist, but my best guess would be AV nodal reentrant tachycardia or AVNRT).

The maneuver is called valsalva, one of several vagal maneuvers that essentially work by increasing the parasympathetic input to the heart and negating some of the sympathetic (fight-or-flight) input.

Oh no worries, I appreciate that you take the time to inform me! It'll be fun to google those terms and dive into wikipedia & co :)

> Since I've picked up mindfulness and become a more balanced, calm person

Where did you learn mindfulness from? A book, therapy, or something else?

Is there anything you wish you knew when you had just started getting into mindfulness? I'm curious as to what you'd suggest.

A book suggested to me by my therapist. It's a Dutch one so probably useless to you.

> Is there anything you wish you knew when you had just started getting into mindfulness?

I wish it was made more clear to me that this is an evidence-based method with plenty of scientific support for its effectiveness, so I would have been less sceptical and picked it up sooner! My therapist was kind of... let's just say that his master thesis was on astrology.

I imagine this is a pretty murky area of medical science; there are so many confounding factors. It could be anything ranging from physical inactivity caused by depression ('psychomotor retardation') to abnormal hormone/catecholamine fluctuations or levels having some larger systemic effect.

Even in the more well-defined case of acute heart failure caused by 'stress' (Takotsubo Cardiomyopathy [0], or Broken Heart Syndrome) there's still a great deal of uncertainty about the exact cause.

All that aside, I really do hope things get better for you (or at least don't become unmanageable). My depression has gotten completely out of control for the past two years, and this has coincided with a noticeable decline in my physical health (including high blood pressure). It sucks.

[0] https://en.wikipedia.org/wiki/Takotsubo_cardiomyopathy#Cause...

Depression is also known to cause chronic levels of inflammation, which is certainly hard on the cardiovascular system.

Does HBP run in your family. I'm 30 and have both HBP and Mixed Episode Bi-polar disorder. I've been told by my docs that they both are usually influenced by genetic conditions. Half the time the doctors disagree on what numbers actually represent high blood pressure. I had one lecture me about putting stress on my organs and that I needed to be on meds now to another saying it's not even bad enough to treat. I opted to try to meds and they seem to work so far.

I'm pretty athletic and fit but also have to fight through periods of depression. It would be interesting to know more about the mechanisms involved and if my otherwise healthy lifestyle could compensate for any negative effect. The study seem a bit light on details.

It means that there is a correlation between "depressed mood and exhaustion" and cardiovascular deaths. The paper does not demonstrate a causal relationship between the two.

Have you ever had your blood pressure taken while standing?

My BP reading is >10 points higher when I am sitting. Apparently, that's a thing for a small percentage of people.

Deleted - not a helpful comment.

Have you been tested for food intolerances/allergies? Especially wheat? Do you also suffer from atopic dermatitis?

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