Emotional stressors trigger cardiovascular events.
OBJECTIVE
To describe the relation between emotional stress and cardiovascular events, and review the literature on the cardiovascular effects of emotional stress, in order to describe the relation, the underlying pathophysiology, and potential therapeutic implications.


METHODS
Targeted PUBMED searches were conducted to supplement the authors' existing database on this topic.


RESULTS
Cardiovascular events are a major cause of morbidity and mortality in the developed world. Cardiovascular events can be triggered by acute mental stress caused by events such as an earthquake, a televised high-drama soccer game, job strain or the death of a loved one. Acute mental stress increases sympathetic output, impairs endothelial function and creates a hypercoagulable state. These changes have the potential to rupture vulnerable plaque and precipitate intraluminal thrombosis, resulting in myocardial infarction or sudden death.


CONCLUSIONS
Therapies targeting this pathway can potentially prevent acute mental stressors from initiating plaque rupture. Limited evidence suggests that appropriately timed administration of beta-blockers, statins and aspirin might reduce the incidence of triggered myocardial infarctions. Stress management and transcendental meditation warrant further study.
Heart Institute, Good Samaritan Hospital, Los Angeles, CA, USA.
B G
BG
Schwartz
W J
WJ
French
G S
GS
Mayeda
S
S
Burstein
C
C
Economides
A K
AK
Bhandari
D S
DS
Cannom
R A
RA
Kloner
D002318:Cardiovascular Diseases / Q000523:psychology* / Q000628:therapy; D004190:Disasters; D055866:Earthquakes; D006801:Humans; D019122:Meditation; D015985:Precipitating Factors; D012111:Residence Characteristics; D012307:Risk Factors; D013177:Sports / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications*