Why Chronic Stress Breaks the Heart, and How to Build Resilience

Stress can damage a heart whose arteries are perfectly healthy. That is the uncomfortable premise cardiologist Tara Narula brings to Lewis Howes, and it grows out of a habit she built in her own exam room: asking every patient the same opening question. The answers rarely concern cholesterol or blood pressure. They concern being overwhelmed, anxious, and depressed. From that observation Narula argues that medicine has split the body from the mind in a way that leaves patients drowning, and that the stress response itself, the system that evolved to help us survive a predator, has become something people keep switched on all day. Her framework, laid out in her book The Healing Power of Resilience, moves through acceptance, flexible thinking, purpose, and real social connection, and treats resilience as a skill to practice long before a crisis arrives.

What Do Heart Patients Really Say When You Ask How They Are?

Picture the scene she describes. A patient sits down, the cuff goes on, and the cardiologist asks the question she asks everyone: how are you? The clinical reflex is to reach for numbers. What Narula kept hearing was something else. Patients told her they were stressed, depressed, anxious, and overwhelmed by what was happening in their lives. Many of them cried.

She was candid that this surprised her, and that it changed how she thought about her job. "Here you have a cardiologist, but my office space was being filled with people who weren't talking about what their blood pressure numbers were at home," she told Howes, describing patients who were talking instead about their mental, social, and emotional load. For many of them, the most valuable thing in the appointment was simply having a safe place to say, "I'm not doing okay." Her summary is blunt. People thanked her for listening, not for a lower reading on the cuff. "We were really missing the boat in terms of what people really need," she said.

That is the first idea worth carrying out of the conversation: the emotional state of a patient is clinical information, and the medical system is poorly built to collect it.

Is the Heart Problem Causing the Stress, or the Stress Causing the Heart Problem?

Howes pushes on the chicken-and-egg question, and Narula does not pick a side. Sometimes a serious diagnosis produces the stress. Sometimes stressful circumstances produce the chest pain or the physical symptoms. "I think it's definitely both," she said. The point she wants listeners to hold is the loop. She put it this way: "It's like this circle, this cycle and you have to fix both."

This is where she is most pointed about the phrase "mind-body connection." Clinicians say it constantly, she argued, yet "we haven't done a great job explaining to people how intricately tied what happens up here is to here." The practical consequence is what she sees in her patients. Someone who is depressed, dealing with money trouble, caring for an ill spouse, or watching a child struggle with addiction may be unable to take medication consistently or even get to a test. "They're drowning under the weight of everything else," she said. Treating the heart without addressing that weight can fail for reasons that have nothing to do with the arteries.

What Happens When the Stress Response Never Switches Off?

Narula frames the problem with an image worth remembering. The stress response was designed for acute danger: something is chasing you, you turn it on, you run, and then it turns off. The modern problem, in her telling, is chronic activation. "Literally imagine people walking around with the stress response turned on in the dial 10 position every day over and over again," she told Howes. That sustained activation is where the damage accumulates.

She draws on the classic model of stress research to describe how the process unfolds. In the words she used with Howes, there are three phases. The first is an alarm phase, the "oh my gosh, what's happening?" moment. The second is resistance, a state of pushing against the stress. The third is exhaustion, the point where you cannot keep fighting anymore. That final stage is burnout, and it is the stage where Narula sees people become chronically ill. Burnout, in other words, is not a personality failure or a vague feeling of tiredness. It is the endpoint of a physiological system that has been asked to stay on for too long.

"You literally burn out because you just cannot fight anymore. And that's the part where we see people get chronically sick from chronic stress." (Narula, in conversation with Lewis Howes, around 12:38)

The episode's own description adds the number that gives this weight. Citing a study across 52 countries, it notes that chronically stressed people are twice as likely to have a heart attack. It also flags broken heart syndrome, a condition that can follow the death of someone you love or even a dramatic positive event such as winning the lottery. Stress is not a soft risk factor sitting next to cholesterol. It can be an acute cardiac event in its own right.

Why Does Simply Talking Help the Body Settle?

This is the part of the conversation that many listeners will find least intuitive, and Narula treats it with the most care. She described patients whose blood pressure was elevated when they arrived, which is common because people are nervous in medical settings. Her standard practice is to take it more than once. But over a conversation, she said, readings can come down. "You definitely can," she answered when Howes asked whether a 30-to-60-minute conversation could lower it.

What drives that change, in her account, is a three-part sequence. First, provide a space to open up. Second, validate and normalize the fact that it is okay not to be okay. Her patients often respond to that second step with surprise: "Thank you for telling me it's okay that I don't feel great." Third, she tells patients to seek therapy, a recommendation that often surprises people coming from a cardiologist. She is explicit about the mechanism: "There's so much relaxation and dialing down of the stress response that comes from just communicating and verbalizing how you're feeling." Having someone in your corner who is non-judgmental, she said, "can do wonders for just helping you decompress and take the stress level down."

She is also clear that therapy need not be reserved for diagnosed illness. A patient does not have to have depression or anxiety to benefit from a standing appointment, once a week or once a month, simply to "download."

How Do You Actually Practice Resilience Before the Crisis?

Narula is frank that the access problem is severe. Patients tell her they cannot find a therapist, that the waiting list is two months long, that the fees are thousands of dollars. She calls this a crisis in the country and says it frustrates her, because the goal is prevention. In cardiology, the aim is to stop the heart attack or stroke before it happens by controlling risk factors. Mental well-being belongs in that same preventive frame.

That is why her book is organized around resilience rather than rescue. In its pages, as the episode description summarizes, she lays out eight tools and walks through acceptance and flexible thinking, then makes the case for purpose and genuine social connection. Those are the practices she wants people to build when the stress is still manageable, so that the capacity exists when they need it. The description's closing line gets the intent right: the aim is to start practicing resilience before you need it.

Narula's own story gives the theme its urgency. At 22, in medical school, she lost vision in part of her right eye. For weeks she read every stumble as evidence that something worse was coming. A note card from her mother, carrying the Serenity Prayer, is what pulled her out of that spiral. The episode description presents it as the moment the spiral broke, and it is a useful reminder that resilience often arrives as a small, specific thing rather than a grand insight.

Where to go from here

Start with the question Narula starts with. Ask the people in your life how they are, and then actually listen to the answer, the way she learned to listen to patients who cried in her office. If the answer is "stressed" or "overwhelmed," treat it as a health signal, not a personal weakness. Consider whether a standing conversation with a non-judgmental listener, whether a therapist or a trusted friend, might do for you what she describes doing for patients. And if you want the full framework, read The Healing Power of Resilience, where she develops the eight tools that she walks through with Howes. The episode is worth your full hour, and then the call to a friend for coffee she describes is a fine next step.