Emotional triggers in myocardial infarction: do they matter?

Abstract

Considerable excitement and interest have arisen recently concerning the role that acute emotional triggers may play in precipitating a myocardial infarction (MI). Observational studies have found repeatedly that patients report excessive anger, anxiety, sadness, grief, or acute stress immediately prior to onset of MI, and recent meta-analyses summarizing these findings reported strong associations between MI occurrence and many of these acute emotions. However, it is unclear whether and through what mechanisms acute emotional triggers might influence MI, and whether there is any clinical utility in knowing if or how emotions trigger MI. We debate whether emotional triggers matter by reviewing the recent evidence for the association between acute emotional triggers and MI and by describing the potential pathophysiological characteristics and mechanisms underlying this association and the preventive strategies that could be used to mitigate the risk of acute MI. We also examine whether the study of emotional triggers could influence clinical risk management or changes in clinical practice/management. We offer suggestions for research that might shed light on whether emotional triggers could initiate a paradigm shift in preventive cardiology, or whether acute emotional triggers are either intractable catalysts for, or merely an epiphenomenon of, some MIs.

Effects of Concurrent Depressive Symptoms and Perceived Stress on Cardiovascular Risk in Low‐ and High‐Income Participants: Findings From the Reasons for Geographical and Racial Differences in Stroke (REGARDS) Study

“…This latter finding is consistent with a recently proposed psychosocial “perfect storm13” model 13 of CVD risk that suggests an underlying vulnerability (eg, depression) is associated with greater risk of cardiac events and mortality, particularly in the presence of perceived stress. Although examinations of the association between depressive symptoms or stress and CVD are increasingly common,4, 6, 7, 8, 9, 14, 15, 16, 17, 18, 19 fewer studies have examined the combined effects of depressive symptoms and stress 10, 11. The perfect storm model emphasizes the importance of considering the convergence of a variety of factors that contribute to CVD risk rather than focusing on 1 risk factor in isolation.…”

Stress-induced release of matrix metalloproteinase-9 in patients with coronary artery disease: The possible influence of cortisol

“…Bouts of psychological stress also trigger cardiac events and this effect may be stronger in individuals with unfavorable psychological attributes, such as low coping skills and depressive mood (Edmondson et al 2013). Still, it is unclear why some individuals are more susceptible to emotional stress than others and many questions remain to be answered about the mechanisms by which stress influences the cardiovascular risk.…”

Anksioznost in koronarna bolezen srca

“…Čustveni sprožilec in anksioznost delujeta preko sprememb v hemodinamiki in hemostazi (47). Te spremembe pa vodijo do tromboze koronarnih arterij prek hemodinamskih učinkov na aterosklerotične plake ali aktiviranja protrombogenih faktorjev in de novo tromboze (47).…”

“…Te spremembe pa vodijo do tromboze koronarnih arterij prek hemodinamskih učinkov na aterosklerotične plake ali aktiviranja protrombogenih faktorjev in de novo tromboze (47). Aktivirata živčno-hormonski sistem, hipotalamično-hipofizno-adrenalno os (HHA-os) in simpatični živč-ni sistem, ki imata sistemske in lokalne učinke (47)(48)(49). Zaradi vazokonstrikcije se poviša krvni pritisk, pospeši se prevajanje iz sinusnega vozla in poviša frekvenca srca (47)(48)(49).…”