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Angina of emotion
‘…Every affection of the mind that is attended with either pain or pleasure, hope or fear, is the cause of an agitation whose influence extends to the heart…. A strong man who, having recieved an injury and affront from one more powerful than himself, and upon whom he could not have his revenge, was so overcome with hatred and spite and passion, which he yet communicated to no one, that at last he fell into a strange distemper, suffering from extreme oppression and pain of the heart and breast….’
Exercitatio anatomica de motu cordis et sanguinis in animalibus
W Harvey, Frankfurt-am-Main, 1628
Although recognised in poetry and literature for centuries, the link between the heart and mind has been addressed scientifically only in the past 200 years through anatomical and physiological studies of the autonomic nervous system. Psychologically driven effects on the heart are not necessarily subtle or without significant implications: evidence suggests a causal relationship between autonomic activity and sudden cardiac death (SCD) due to ventricular tachycardia (VT)/ventricular fibrillation (VF).1–3 The precise mechanisms by which brain activity influences cardiac electrophysiology are now coming to light in the new era of functional neuroimaging and advances in molecular cardiology that link arrhythmogenic mechanisms to mental stress via the autonomic nervous system. These brain–heart interactions help explain the apparent randomness of sudden cardiac events and provide novel insight into future potential therapeutic targets. This review examines what is currently known about the effects of higher brain centres and autonomic control loops on the heart with particular relevance to arrhythmogenesis.
Figure 1 presents an overview in which the brain, autonomic nerves and heart are considered as an interactive system. In the brain a number of regions are highlighted that are engaged in autonomic processing. Mental stress or emotion are processed in a network …
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