Family history- Significant for premature heart disease (men age 55-65 ). Race

Stress. Many stress reactions (increase in heart rate, blood pressure, increase in blood cholesterol, blood sugar, clotting factor, rapid, shallow breathing, constricted arteries) strain the heart. Chronic stress can have a major impact on heart disease. Stress makes coronary arteries absorb more cholesterol. People who faced high psychological demands without having much control had 3 times the risk of high blood pressure and heart problems. Under conditions of intense stress, even the muscle fibers inside the heart can begin to contract so vigorously that the normal architecture of these fibers is disrupted, damaging the heart muscle. Feelings of frustration, tension, sadness doubled risk of heart attack in subsequent episodes.

High fat diet. Proper diet maintained for 6 months reduces risk and lowers cholesterol by 13%.

Depression. Doubles risk for heart disease.

Anger and Hostile type A personality. Type As secrete more stress hormones. 14% of doctors and 20% of lawyers with high hostility were dead by 50, only 2% of non hostile doctors and 45 lawyers were dead at 50. Cynical mistrust of people, frequent anger, overt expression of anger, temper outbursts, tense posture, completing sentences for other people, multitasking, time urgent, cynical about world are characteristics. High correlation with heart disease. Chronic SNS arousal. Interventions: Chill out (2 min.), imagine cooler place, assertiveness skills–problem solving, change environment (people who have taken only 1 vacation in 3 years twice as likely to die of heart disease; 1 in 6-7 years, 7 times as likely.

Lack of social support or isolation. If you don’t have someone who really cares for you and in whom you can confide, you have 3 to 5 times higher risk of premature death from all causes. People with heart attacks, 4 times the risk of dying if no social support. Cardiac arrhythmia trial–six times as many died who did not have pets as those who did. Strong relationship between low HDL and lack of social support.

High homocysteine levels. Folic acid is believed to help lower levels.

Diabetes. Sugar damages arterial walls.

Smoking. 20-40% of Coronary deaths are directly attributed to smoking. Quitting reduces risk quickly, within 5-10 years difference is negligible.

Sedentary. 60% of Americans are sedentary. Exercise program lowers risk by 30-50%.

Obesity

Depression. Doubles risk for heart disease.

Anger and Hostile type A personality. Type As secrete more stress hormones. 14% of doctors and 20% of lawyers with high hostility were dead by 50, only 2% of non hostile doctors and 45 lawyers were dead at 50. Cynical mistrust of people, frequent anger, overt expression of anger, temper outbursts, tense posture, completing sentences for other people, multitasking, time urgent, cynical about world are characteristics. High correlation with heart disease. Chronic SNS arousal. Interventions: Chill out (2 min.), imagine cooler place, assertiveness skills–problem solving, change environment (people who have taken only 1 vacation in 3 years twice as likely to die of heart disease; 1 in 6-7 years, 7 times as likely.

Lack of social support or isolation. If you don’t have someone who really cares for you and in whom you can confide, you have 3 to 5 times higher risk of premature death from all causes. People with heart attacks, 4 times the risk of dying if no social support. Cardiac arrhythmia trial–six times as many died who did not have pets as those who did. Strong relationship between low HDL and lack of social support.

Fast-paced city. New York City is coronary capital.

Energetic qualities of the Heart

Single heart cells taken from different hearts will beat in unison when put together.

The heart nourishes itself first before the rest of the body. Coronary arteries crown the heart and carry freshly oxygenated blood to the heart itself.

Heart has mediating function in meeting of our earthly and spiritual natures. The heart produces hormones which affect the circulatory homeostasis. Heart chakra is where the lower chakras are transformed to the the spiritual chakras. Love and compassion for ourselves and others and for life itself are embodied in the heart.

Heart energy is expressed through the touch of the hands and eyes. When we experience the heart as full and present without fear, we are able to reach out through the eyes and hands to give and receive. When the hands and eyes meet the environment, supported from within, then we are nourished by the outer world. When the heart withdraws, it does not support the hands and eyes and this connection between the eyes and hands and heart is lost. The connection between the inner and outer world through the heart is broken. Old wounds and brokeness surrounding the inner core are felt here, building layers of defense as arterial plaque as well as psychological defenses. The heart dies onto itself. We can no longer live fully, emotionally of physically.

Expression of the feelings of the heart is the essence of humanity: Communication, nourishment for ourselves and others, the power to heal and wisdom of right relationships are expressed through the heart.

The energy of the heart, when frustrated, turns in and down to manifest in strong emotional forms such as depression, hurt or anger through the solar plexus.

Blood flow: Blood is the fluid which brings life energy to all parts of the body, nourishes and communicates, purifies and carries away waste.

If blood does not flow freely, we don’t receive full energy or process wastes. If we do not process emotions, they become pent up and our feelings poison us. Through the flow of blood, emotions held in other body tissues such as glands and organs are moved outward and find expression.

Pulse is fundamental rhythm of life–contract and release, expand and contract, movement and stillness, life and death.

The Dr. Dean Ornish Lifestyle Model for Reversing Heart Disease

Exercise-Diet-Stress management-Group support

Comparison chart on effects of these components

Research shows that Ornish participants who followed the diet and exercise requirements, but did not do the stress management (yoga ), did not reverse their heart disease. Only those who practiced yoga one hour a day for seven days/week reversed their heart disease (plaque in arteries diminished).

Implications for Yoga Teachers

Stress and Heart Disease (handouts). Mortality would go down if people learned to listen to their body, got help sooner.

Interventions for stress: Opening up, journaling, expressing feelings, optimism, social support (including pets), mindfulness, being in present, problem solving, drop goals and focus on moment, engage in healthy pleasures (sights, sounds, smells, touch, mentally engaged, time-outs), laughter. Longevity predictors: mentally engaged in novel activities daily.

Teaching in different settings. Yoga teachers might team up with a psychotherapist to add group support work to stress management. Cardiac Rehab in hospital setting usually focuses just on exercise. There is potential to expand cardiac rehab to include other lifestyle interventions. Fitness Centers and Large cardiology centers may be potential linkages.

A Yoga Class for Heart Patients

Relaxation and the hard-driven, high achiever.

Using familiar language

Body/mind connection and the heart

Symptoms to watch for: shortness of breath, chest discomfort (pressure, burning, ache, squeezing in chest, arms, jaw, neck, and between shoulder blades), dizziness, dizziness with change of level as in sitting to standing or turning, sweating, gastric upset, fluttering heart beat.

Have an emergency plan. Good idea to know CPR and know where nearest phone is for calling 911.

Special Considerations and Contraindications for Heart Patients

Recent Surgery. If student has had recent by-pass surgery, there will be soreness, stiffness in the chest area. Cobra, for example, will be very restricted. Discourage straining. Avoid lifting and holding of arms. Also, arterial grafts are taken from the leg, so there may be discomfort, restriction in the leg.

Inversions (postures with head lower than the heart). Avoid inversions for people with unstable high blood pressure. If blood pressure is controlled, inversions are OK, but do not hold very long.

Postural Changes. Limit changes in levels or do slowly. People on high blood pressure medication may experience dizziness in changing levels suddenly.

Arm Extensions. Encourage resting of arms in standing positions. Do not hold arm extensions for long periods as this may strain the heart. Remember that arms and hands are the "wings of the heart," so flowing and open movements with arms and hands are good. Breathing into the mid lobes of the lungs is helpful to support lift of the arms.

Neck Flexion/Extension/Twisting. Heart patients may have blocked carotid arteries, so keeping head in neutral positions may be necessary for some individuals. For example, in twists, do not turn head too forcefully. Use eyes to extend twist rather than straining to turn the neck. Modified shoulder stand may put too much pressure on neck unless head is supported.

Other Problems.

Many heart patients are older and may have arthritis–back, hip, knee pain and restrictions. Tension in neck and shoulders and/or arm and shoulder pain may be common. Postures may need to be modified, done more slowly with less holding, use props.
Also, heart disease is common in diabetics. Diabetics may have retinal neuropathy, so avoid inverted postures. Also diabetics may not have good sensation in their feet and limbs. Be cautious with balancing poses.

A number of poses are contraindicated for abdominal aortic aneurysm, if this condition is known. Be cautious in any postures that put pressure on the abdominal area.

Discourage strain. Heart patients may be disconnected from their bodies and may not realize their own physical limitations. Remind them less effort means more benefit.

Maintain slow pace. Heart patients are often people who do everything fast--talk fast, walk fast, eat fast, etc. Give them the experience of slowing down and going deeper.

Be vigilant about any signs of distress. Heart patients may not want to admit anything is wrong. Note redness in the face, shortness of breath, holding of breath, dizziness or obvious signs of pain or strain.

Encourage breathing. Heart patients tend to be chest breathers and may have breath-holding habits. Remind them to breathe, but discourage exaggerated breathing.

Use props. Each person should have two pillows and two blankets, a mat and a chair. Encourage them to experiment with using the props to make themselves really comfortable.

Emphasize conscious awareness and connection to inner feelings. Be sure they understand yoga is not mindless calisthenics, but is a method of bringing body, mind, and breath together. That takes continuous sensing, feeling, awareness and being present in the moment.

Speak gently and respectfully. As a teacher, model this gentleness. Use "Please" or "See if it feels comfortable to…" rather than make commands. This makes participants feel they are in control and encourages them to be gentle with themselves.

Be sensitive to cultural differences. Those with fundamentalist religious backgrounds may be very leery of yoga because comes from a non-Christian, foreign culture. Use the term stress management more than yoga and emphasize that this is not a religion. Don’t do chanting, unless you know your students well!

Reinforce the goal of peacefulness and relaxation. The goal is not to do the form of the pose exactly or to stretch further or attain a more difficult posture. Rather the goal is to experience greater peace and relaxation and to learn to carry that into every day living. This may be hard for the highly competitive person.

Add relaxation between postures. This reinforces the idea of letting go of activity and finding space to relax.

Reinforce the concept that peace comes from within. Place of stillness is within not something obtained from outside.

Remove expectations for meditation. Meditation is not easily understood and heart patients will try to figure out analytically what they are supposed to accomplish. They want to know when they have gotten "there." Remind them not to try to accomplish anything or have any goals, just be present.

Maintain a sense of humor. Humor itself is healing!

A Philosophy for Living a Less Stressful Life

At the End of the Day, Ask Yourself:

Did my thoughts, actions and deeds contribute to the well-being of others?

Did I ask more from others than I needed?

Did resistance to change cause harm to myself or others?

Did my words express the truth from my heart?

Did the choices I made nourish myself?

Did I pause to give thanks for at least one gift in my life?

Did I take time to notice the omnipresence of a power beyond myself?

At the end of the day, am I at peace with myself?