Acute psychosocial stress and cardiovascular events

doi:10.1053/ajem.2002.34788

The American Journal of Emergency Medicine

Volume 20, Issue 5, September 2002, Pages 488-491

https://doi.org/10.1053/ajem.2002.34788 Get rights and content

Abstract

Stressful life events can trigger acute myocardial infarction and sudden cardiac death. Victims of natural disasters, such as earthquakes and other conditions of extreme stress should be evaluated for physical injuries as well as for cardiac disease. (Am J Emerg Med 2002;20:488-491. Copyright 2002, Elsevier Science (USA). All rights reserved.)

Section snippets

Experimental studies

Mental stress produces significant increases in heart rate and blood pressure that may lead to increased myocardial oxygen demand and plaque disruption.¹⁴ In addition, to an increase in the rate pressure product, there is also evidence that mental stress may lead to a primary reduction in myocardial oxygen supply. Whereas coronary arteries of normal patients dilate during mental stress, impaired dilatation and even vasoconstriction has been shown in atherosclerotic arteries.¹⁵ Although not all

Clinical studies

An increase in cardiovascular events has been associated with disasters. An increased relative risk for cardiovascular death (relative risk, 2.6) and a sharp increase in number of admissions for acute myocardial infarction (relative risk, 1.8) were observed after the 1994 Los Angeles earthquake, which occurred in the early morning, compared with the week before the disaster.10, 11 Sixty-five percent of those who died from atherosclerotic cardiovascular disease were men and their average age was

Conclusions

An extensive literature review supports a role for mental stress as a trigger of myocardial infarction. Because stressors provoking anger are frequently unavoidable, benefit may be gained through interrupting the link between the stressor and the cardiovascular event by nonpharmacologic and pharmacologic means. Aspirin and β-blockers may be warranted in selected populations, particularly at times of increased stress such as after bereavement. Moreover, although the proportion of individuals

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Cited by (53)

A novel restrainer device for acquistion of brain images in awake rats
2024, NeuroImage
Functional neuroimaging methods like fMRI and PET are vital in neuroscience research, but require that subjects remain still throughout the scan. In animal research, anesthetic agents are typically applied to facilitate the acquisition of high-quality data with minimal motion artifact. However, anesthesia can have profound effects on brain metabolism, selectively altering dynamic neural networks and confounding the acquired data. To overcome the challenge, we have developed a novel head fixation device designed to support awake rat brain imaging. A validation experiment demonstrated that the device effectively minimizes animal motion throughout the scan, with mean absolute displacement and mean relative displacement of 0.0256 (SD: 0.001) and 0.009 (SD: 0.002), across eight evaluated subjects throughout fMRI image acquisition (total scanning time per subject: 31 min, 12 s). Furthermore, the awake scans did not induce discernable stress to the animals, with stable physiological parameters throughout the scan (Mean HR: 344, Mean RR: 56, Mean SpO₂: 94 %) and unaltered serum corticosterone levels (p = 0.159). In conclusion, the device presented in this paper offers an effective and safe method of acquiring functional brain images in rats, allowing researchers to minimize the confounding effects of anesthetic use.
Impact of Earthquake on Cardiovascular Health: What Should Cardiovascular Healthcare Providers Anticipate After the Devastating Earthquakes in Turkey and Syria?
2023, Current Problems in Cardiology
Natural disasters like earthquakes have direct and indirect association with major adverse cardiac events. They can impact cardiovascular health by multiple mechanisms not to mention their impact on cardiovascular care and services. Besides the humanitarian tragedy that calls attention globally, we as part of cardiovascular community are concerned with the short and long outcomes of those who survived the recent Turkey and Syria earthquake tragedy. Therefore, in this review, we aimed to draw attention of cardiovascular healthcare providers to the anticipated cardiovascular issues that may arise in survivors on short- and long-term postearthquakes to ensure proper screening and earlier management of this population. With the anticipated increase in natural disasters in future considering climate changes, geological factors, and human activities, the cardiovascular healthcare providers as part of medical community should be aware of the high rate of cardiovascular disease burden that can occur among survivors of earthquakes and other natural disasters, so, they should act accordingly in terms of preparedness measures, adequate response planning starting from services re-allocation to personnel training and enhancing access to medical and cardiac care in both acute and chronic contexts, not to mention screening and risk-stratifying the patients to optimize their management.
Acute Psychological Stress is a Trigger for Stroke: A Case-Crossover Study
2020, Journal of Stroke and Cerebrovascular Diseases
Citation Excerpt :
The interview schedule sought information on demographic details of patients, known risk factors, medical history, signs and symptoms of stroke, time of onset of stroke, data on exposure to triggering factors during hazard periods and control periods. The pro-forma had been pretested in a previous study.9 Patients were interviewed within 7 days after the event.
Conventional risk factors for stroke that have been identified are mostly chronic diseases that explain much of the variation as to who develops stroke. However, these risk factors do not equip us with the means to predict when an event like stroke will occur. It has been observed that acute events like stroke and coronary heart disease are preceded by episodes of acute stress. The present study was undertaken to determine whether acute psychological stress is a potential triggering factor for the occurrence of stroke.
In accordance with the case-crossover study design, patients or Legally Authorized Representative (LAR) were asked to report psychological stress during the two-hour hazard period before the event and during the control period, which was the same 2-hour time period the day before the event. Conditional logistic regression was used to compare each person's exposure during the hazard period to their exposure during the control period.
A total of 151 stroke patients were interviewed. Acute psychological stress was associated with transient increased odds of stroke in the subsequent 2 hours that was 3.4 times higher than the odds during periods with no exposure to these triggers (95% confidence interval 1.55-7.50).
Acute psychological stress is a potential independent triggering factor for the occurrence of stroke. Further confirmatory studies are required to help corroborate these findings and elucidate the mechanisms underlying this short-term increase in risk.
Psychopharmacology and Cardiovascular Disease
2018, Journal of the American College of Cardiology
This review discusses common mental health disorders and their associations with cardiovascular disease risks. Commonly found mental health disorders include depression, anxiety, and personality types. The link between depression and cardiovascular disease mortality has been established. Depression is also common in patients with heart failure. In addition to discussing psychological disorders, a review of psychotropic drugs is also included. Drugs are described for therapy for depression and anxiety, as well as associations with cardiovascular drug-drug interactions. Drug-drug interactions are more common and potentially dangerous in elderly patients, in whom the conditions often coexist. The most common drug-drug interactions involve the P450 system of enzymes.
Acute restraint stress provokes sudden cardiac death in normotensive rats and enhances susceptibility to arrhythmogenic effects of adrenaline in spontaneously hypertensive rats
2016, Legal Medicine
Citation Excerpt :
High incidences of cardiovascular events and sudden cardiac death (SCD) have been reported following unexpected acute psychosocial stress [1–6].
A high incidence of cardiovascular events and sudden cardiac death (SCD) has been reported following unexpected acute psychosocial stress. The possible pathways by which acute restraint stress (ARS), a kind of acute psychosocial stress, leads to SCD were determined.
Using 16-week-old male normotensive Wistar Kyoto rats (WKY, n = 24) as controls and spontaneously hypertensive rats (SHR, n = 24) as the hypertensive subjects with left ventricular hypertrophy (LVH), we assessed ARS-related incidence of SCD, cardiac and myocardial autonomic nervous system dysfunction, gap junction connexin-43 (Cx43) channel remodeling, and ventricular repolarization abnormality, based on electrocardiography, an adrenaline test, heart rate variability (HRV), and reverse transcriptase polymerase chain reaction analyses. Rats with ARS were introduced into restrainers that allowed head, limb, and tail movement.
In normotensive hearts without LVH, ARS induced a higher incidence of SCD attributed to lethal bradycardia, increased cardiac and myocardial sympathetic activation, and gap junction Cx43 channel remodeling, as evidenced by the increases in the ratio of low-frequency and high-frequency powers in HRV, the ratio of myocardial neuropeptide Y (NPY) and acetylcholinesterase (AChE) mRNA expressions, and the up-regulation of LV Cx43 mRNA expression; in hypertensive hearts with LVH, ARS enhanced susceptibility to the malignant arrhythmogenic effects of the adrenaline test (a kind of sympathetic stimuli) accompanied by abnormal ventricular repolarization, as evidenced by increased incidence of ventricular tachycardia and/or ventricular fibrillation during the adrenaline test and prolonged QTc immediately after ARS.
ARS may trigger cardiac and myocardial sympathetic predominance, and then induce gap junction Cx43 channel remodeling, finally leading to lethal bradycardia in normotensive WKY. ARS-induced abnormal ventricular repolarization may be responsible for ARS-enhanced susceptibility to sympathetic stimulation in SHR with LVH. Expressions of myocardial NPY, AChE, and Cx43 genes, HRV, QTc and LVH measures showed diagnostic and prognostic potential for predicting ARS-induced SCD.
Philemon and Baucis syndrome: Three additional cases of double deaths of married couples
2013, Forensic Science International
Citation Excerpt :
This specificity was well explained by Ciesiolka et al. [1] and can lead to acute psychological stress. Severe psychological disturbance may be the trigger for acute coronary or rhythmic disorders [10]. Many experimental and clinical observations have been made, especially during mass disasters.
The simultaneous death of two people is immediately considered as a suspect. However, this feeling is reinforced when the individuals are spouses. In these situations, criminal and forensic investigations are required to establish whether or not the deaths were homicidal in nature. Despite many descriptions of simultaneous deaths being present in the literature, the simultaneous death of two spouses from natural causes is poorly described with Ciesiolka et al., Department of Legal Medicine in Gießen (Germany), being the only ones to have reviewed two case reports involving these circumstances. The scarcity of this type of information in the literature renders the task of claiming natural simultaneous death as the final outcome of an investigation difficult. We would like to report three additional cases with the aim of better describing this type of event.
In all three cases, the bodies were those of a married couple in their 80s. The bodies were discovered in the same room. In each case, the death of one of the spouses could be attributed to natural cause; however the death of the other spouse could not be determined with certainty, and shared several similarities in all cases: simultaneity in death; a pre existing cardiovascular disease/disorder; a certain degree of fragility and dependence on the other spouse whose death could lead to acute psychological stress.
Intense psychological disorder could trigger acute coronary or rhythmic disorders. The mechanisms by which brain activity influences cardiac electrophysiology are now known to take place via the autonomic nervous system mediation. This brain activity could provide an explanation for the death of the individuals with pre-existing heart conditions, who underwent significant stress upon occurrence of the death of their partners.
The death of these individuals, which took place at the same place and time as their deceased spouses, can be attributed to natural causes: the Philemon and Baucis syndrome.

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^*: Address reprint requests to Ruth Stalnikowicz, MD, Hadassah University Hospital, Mount Scopus, PO Box 24035, Jerusalem, 91240 Israel.

^**: 0735-6757/02/2005-0009$35.00/0

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ReviewsAcute psychosocial stress and cardiovascular events*,**

Abstract

Section snippets

Experimental studies

Clinical studies

Conclusions

Am J Cardiol

Am Heart J

Lancet

J Am Coll Cardiol

J Am Coll Cardiol

Lancet

J Am Coll Cardiol

Lancet

Seven years survival of patients with normal or near normal coronary angiograms: ACASS registry study

J Am Coll Cardiol

Imipramine in patients with chest pain despite normal coronary angiograms

N Engl J Med

Long-term clinical course of patients with normal coronary angiography: Follow-up study of 121 patients with normal or nearly normal coronary arteriograms

Am Heart J

Patients with angina with normal and near normal coronary arteries: Clinical and psychosocial state 12 months after angiography

BMJ

Mental stress-induced myocardial ischemia and cardiac events

JAMA

Effects of mental stress on myocardial ischemia during daily life

JAMA

Reviews
Acute psychosocial stress and cardiovascular events*,**