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Acute mental stress responses: neural mechanisms of adverse cardiac consequences
Author(s) -
Esler Murray,
Lambert Elisabeth,
Alvarenga Marlies
Publication year - 2008
Publication title -
stress and health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.009
H-Index - 61
eISSN - 1532-2998
pISSN - 1532-3005
DOI - 10.1002/smi.1205
Subject(s) - mental health , psychology , population , myocardial infarction , sudden cardiac death , psychiatry , medicine , cardiology , environmental health
It has always seemed plausible that short‐term mental stress can act as a trigger for cardiac catastrophes, but the scientific evidence until recently was unconvincing. Panic disorder provides a special case, illustrating that mental stress responses can be a cause of triggered adverse heart events such as myocardial infarction and sudden death. In recent years systematic evidence has been gathered at times of disasters including war, missile attacks on civilians and earthquakes, which also strongly supports the proposition of an acute mental stress–heart attack link. Do these observations have a generality, applicable to the population at large? The answer is that no doubt they do, a finding reached by several national health bodies deliberating on this previously contested question. In individual personal life, ‘emotional earthquakes’ do occur. Heart attacks have been well documented to be triggered when very distressing news has been received involving family members, by armed robbery, assaults and even sporting teams or racehorses losing narrowly (or even winning) after a gripping struggle. The activation of the sympathetic nerves of the heart is of prime importance in such triggering of cardiac catastrophes by acute mental stress. It has always seemed plausible that short‐term mental stress can act as a trigger for the development of abnormal heart rhythm and sudden death in patients with existing heart disease. For many years the existence of this relation of acute mental stress to heart attacks was largely based on individual anecdotes such as the celebrated case of the famous 18th‐century English surgeon John Hunter, who wrote that he was at the mercy of any scoundrel who aggravated him, then subsequently proved the point by dying suddenly in the middle of a stormy meeting of the board of his hospital (Figure 1). Key to understanding the mechanisms by which triggering of heart attacks might occur is consideration of the ways in which the sympathetic nervous system and adrenal medulla are engaged in acute mental stress responses. Copyright © 2008 John Wiley & Sons, Ltd.