Working 2012). The mechanism linking between stressWorking 2012). The mechanism linking between stress

Working professionals as Maria in this scenario have a high risk of coronary heart disease (CHD) as they expose to a specific stress source which is work-related stress. Pro-long psychological stress may lead to serious cardiovascular outcomes such as myocardial infarction (MI), heart attack or even death. CHD refers to illnesses caused by plague built up inside the coronary artery walls and narrowing the lumen diameter, which is known as atherosclerosis. Plague is mainly made up of cholesterol, macrophage, calcium. The plague can gradually build up, harden and finally rupture. When it ruptures, blood clots can be formed on its surface. The consequence is the reduced blood flow, which in turn the flow of oxygen and nourishment to the heart is also reduced. When a blood clot is large enough to completely block ?the flow of blood to heart muscles, a heart attack occurs, known as acute coronary events. Regarding chronic consequence, the heart muscles need to work harder to create more force to transfer the blood flow through the hardened and narrowed arteries with higher resistance than normal arteries, which may lead to heart failure and arrhythmias.Risk factors of CHD is divided into uncontrollable factors and controllable factors. Uncontrollable factors are sex, hereditary, race and age. Controllable factors are high cholesterol and triglyceride levels, diabetes and prediabetes, overweight and obesity, smoking, lack of physical activity, unhealthy diet, stress (NIH). Why is stress a risk factor of CHD? There are two types of stressors: chronic and acute stressors. Many studies examine the association between psychological stress and cardiovascular diseases. It is known that chronic stress increases the risk of arteriosclerosis, while acute stress increases the adverse clinical events. Stress moderately increases the risk of CHD incident (Richardson et al, 2012). The mechanism linking between stress and cardiovascular outcomes is multifactorial, involving the changes in sympathetic nervous system activity and homeostasis. It explains the biological reactivity to stress such as increased heart rates, blood pressure, and cardiac output, higher likelihood of abnormal heart rhythms, and release of stress hormone (Torpy, Burke, & Glass, 2007). Especially, the association between work stress and CHD is believed as a natural cause-effect relationship through direct neuroendocrine stress pathways and indirectly through health-compromising behaviors to cope with work-stress such as smoking, lack of exercise, or excessive alcohol consumption (Chandola et al, 2008).  Other types of acute stress including negative emotion, emotional pressure, and anger also increase the risk of CHD and acute clinical events such as heart attack, angina or death. Many studies show that severe emotional stress such as anger can trigger acute cardiovascular events including MI, cardiac attack or stroke. Plague rupturing and forming blood clot can occur due to the physiological reactivity to the excessively emotional events such as anger or expressing hostility, which explains why acute stress can trigger acute coronary events. In a meta-analysis study, exaggerate expression of anger was reported to be present in 2 hours before myocardial infarction in 2.4% patients. The most popular reasons causing anger were conflicts with family and conflicts at work. (Tofler & Muller, 2006). Prevention for CHD focus on controllable risk factors, which are changing lifestyles, behaviors and diet. Regular medical check-ups, controlling blood pressure and cholesterol level, no smoking, keeping a healthy weight, regular exercise, eating healthy food and stress management are recommended. Specifically, in this case, the client should practice a more effective coping method, problem-focused coping for instance, and seek for social supports to help her manage emotion and stress.  Overall, stress is a significant risk factor for CHD and other cardiovascular diseases. To reduce stress, effective stress management and utilizing all the coping resource and social support is strongly recommended. References:Coronary Heart Disease Risk Factors. NIH. Retrieved on 2018, January 17 from, S., Shaffer, J.A., Falzon, L., Krupka, D., Davidson, K.W., & Edmondson, D. (2012). Meta-Analysis of Perceived Stress and Its Association with Incident Coronary Heart Disease. The American Journal of Cardiology, 110(12),1711-1716., J.M., Burke, A.E., Glass, R.M. (2007). Acute Emotional Stress and the Heart. JAMA, 298(3):360. doi:10.1001/jama.286.3.374Chandola, T., Britton, A., Brunner, E., Hemingway, H., Malik, M., Kumari, M., Badrick, E., Kivimaki, M., & Marmot, M. (2008). Work stress and coronary heart disease: What are the mechanisms. European Heart Journal, 29(5), 640–648., G.H, & Muller, J.E. (2006). Triggering of Acute Cardiovascular Disease and Potential Preventive Strategies. Circulation, 114:1863-1872. DOI: 10.1161/CIRCULATIONAHA.105.596189