[Cardiologists should take this to heart: doctors often do not recognise stress as a risk factor for cardiovascular disease].

The strong association between distress and heart disease is frequently in the news, for example when a celebrity dies after terrible news such as death of a child. Researchers in the Netherlands found that high scores on the Cardiac Anxiety Questionnaire after a myocardial infarction lead to an increased risk of new cardiac events, regardless of underlying cardiac disease severity. Although the brain-heart axis is well known in literature, it is hardly a common subject in daily clinical cardiac practice. Signs and symptoms frequently lead to an 'oculostenotic reflex' instead of proper mental diagnosis. Despite the fact that patients are familiar with stress as a major risk factor, guidelines concerning this relationship are lacking. What can we do to bring about change? By emphasising the integral aspect of patient care in medical education, and by training medical specialists, on the premise that 'you cannot recognise what you do not know'. Recent research confirmed the relationship between stress and atherosclerosis by visual means. Could this be the solution for hesitant doctors: a picture?