There is substantial evidence that emotional stress can trigger acute cardiac events in vulnerable individuals.1 2 Most research on emotional triggers has involved retrospective interviews with survivors of acute myocardial infarction, asking them about the circumstances surrounding the onset of their illness, but, in addition, the impact of natural or human disasters has been studied. Investigations of major events such as earthquakes have the advantages that a population-based sampling methodology can be used, that the timing of stimuli can be defined objectively instead of relying on self-report and that the incidence of cardiac events can be contrasted with levels during non-traumatic comparison periods. The first set of thorough analyses was conducted in the wake of the Northridge earthquake that took place in January 1994 in the Los Angeles area. There was an abrupt increase in sudden cardiac deaths immediately after the earthquake,3 together with a rise in coronary heart disease mortality that was not observed for other cardiovascular diseases or non-cardiac causes.4 Deaths typically occurred among people with advanced coronary atherosclerosis. Acute physiological responses such as autonomic dysfunction and inflammatory, neuroendocrine and platelet activation, coupled with disruption of vulnerable plaque, may be responsible for the onset of …