[Bereavement. The management of mourning: the cardiovascular physiopathology of communication].
Within the communication competence requested to an experienced physician, bereavement has a relevant role. A case of a patient with postinfarction cardiogenic shock admitted to a cardiosurgery department for rescue myocardial revascularization is described; the patient's wife, after communication of the death of her husband during the surgical procedure, developed an acute anterior myocardial infarction with angiographic normal coronary arteries. Pathophysiological issues concerning acute ischemic event triggers are discussed, with particular attention to emotional stress subtypes, their neuronal loops and their interactions with different cardiovascular diseases (arrhythmic, congenital, atherosclerotic). The essential variables of an adequate bereavement are discussed: set, mood, language, cultural background. The sympatho-vagal unbalance induced by emotional stress as an acute ischemic event trigger is emphasized as well as the need for more awareness by health care operators of the emotional impact and adequate management of bereavement.
Roghi
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Dipartimento Cardiologico A. De Gasperis, Azienda Ospedaliera Niguarda Ca' Granda, Milano. albertor@planet.it
D001601:Bereavement; D002320:Cardiovascular Physiological Phenomena; D003142:Communication; D003466:Cultural Characteristics; D017809:Fatal Outcome; D005260:Female; D006117:Grief; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000523:psychology; D010817:Physician-Patient Relations