Stress and the heart: biobehavioral aspects of sudden cardiac death.

Stress has been implicated as a developmental factor in atherosclerotic heart disease, essential hypertension, and sudden cardiac death. This article reviews the mechanisms and biobehavioral effects of stress on the heart, focusing on its relation to sudden cardiac death. Epidemiologic evidence, cultural studies, animal experiments, and human research are reviewed to better understand the biobehavioral aspects of stress on the heart. Emphasis is placed on understanding the interaction of the central nervous system's frontal cortex and hypothalamus with cardiovascular control areas. With today's understanding of the frontal cortex and the interaction of hormones and neurotransmitters with the cardiovascular system, clinical interventions utilizing psychotherapy and psychopharmacology are needed, particularly since both approaches are underutilized in combating arrhythmias.