Emotional stress as a trigger in sudden cardiac death.

The influence of anxiety and depression on cardiovascular disease is well-known in terms of chronic cardiovascular and ischemic states. It happens mostly through diminished cardiac vagal modulation and greater procoagulant activity in depressed patients. But the impact of emotional factors in acute cardiac events is not estimated enough. From the clinician's point of view, there are an increasing awareness concerning external circumstances and external triggering in sudden cardiac death, that is caused by malignant ventricular arrhythmias or myocardial infarction. A number of external, i.e. exogenous factors in everyday life can be implicated in triggering such events. Including heavy physical activity, emotional stressors, meteorologic variables, air pollutants, chronobiologic phenomena, food ingestions, coffee, alcohol etc., emotional stress seems to be among the most often triggers of sudden event. There is a wide range of everyday situations and activities that involves activation of sympathetic nervous system, and emotional stressors are described as trigger caused by sympathetic arousal. Acute emotional arousal can trigger life-threatening arrhythmias and the mechanisms of that risk have been recognized. Acute episode of emotional distress (and notably anger-like stress) may trigger ventricular ectopic beats and tachycardia, as well as acute myocardial infarction. These sudden phenomena can be the result of the endogenous response to external risk of acute emotional stress. Sudden death without antecedent angina, suggesting cardiac arrhythmia, as well as deaths preceded by chest pain, suggesting coronary occlusion were observed in many studies that have led to estimates that between 20 and 40 percent of sudden cardiac deaths are precipitated by acute emotional stressors.