[Stress and myocardial infarction].
BACKGROUND
Stress is characterized by an increase in plasma catecholamines and cortisol associated with a rise in heart rate and blood pressure. Plasma epinephrine can increase by a factor of 8 through emotional or physical stress. In contrast, the rise in plasma norepinephrine following physical stress is much higher than that following emotional stress.
Experimental studies in monkeys suggest a causal relationship between emotional stress and coronary atherosclerosis. This relationship has not yet been convincingly proven in clinical studies. However, clinical studies have clearly demonstrated that emotional stress can trigger the onset of acute myocardial infarction. Life threatening situations like earthquakes are able to increase the risk for myocardial infarction about sixfold. Anger or sexual activity may double this risk. The occurrence of myocardial infarction is not evenly distributed throughout the day. The highest risk in non-treated, non-smoking patients lies between 6 a.m. and noon with a predominance on Monday morning. High physical stress in untrained persons carries a much greater risk for myocardial infarction than extreme emotional stress. This difference may be due to a greater degree of coronary vasoconstriction induced by the higher levels of norepinephrine in physical exercise compared to those during emotional stress.


CONCLUSIONS
A causal relationship between stress and atherosclerosis has not yet been demonstrated in clinical studies. However, there is convincing evidence to accept emotional stress as a potential trigger for the onset of acute myocardial infarction. High physical stress of untrained persons carries an even greater risk for the development of acute myocardial infarction.
Klein
H H
HH
Medizinische Klinik II, Schwerpunkt Kardiologie, Klinikum Idar-Oberstein. medklinik2.io@shg-kliniken.de
D000786:Anger; D000818:Animals; D004644:Emotions; D004837:Epinephrine / Q000097:blood; D015444:Exercise / Q000502:physiology; D000882:Haplorhini; D006339:Heart Rate; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology* / Q000503:physiopathology; D012307:Risk Factors; D012725:Sexual Behavior; D013315:Stress, Psychological / Q000150:complications* / Q000503:physiopathology
D004837:Epinephrine