Anger and acute coronary events.

A high level of anger has a powerful effect on the incidence of preventable cardiovascular death. Persuasive clinical evidence indicates that anger evokes physiological responses that are potentially life-threatening in the setting of CAD. Finally, emotional stress, anger, or worry have a dominant influence on the severity, frequency, and treatment of angina. The natural history of angina is characterized by episodic variations in the frequency and severity of symptoms coincident with periods of emotional stress. When angina is associated with periods of emotional stress or anger, the angina is not usually a result of progressive coronary disease, but rather is due to an increase in oxygen demand. Appreciation of this concept will help to rule out "true" unstable angina due to progressive coronary disease from recurrent angina that results from an increase in oxygen demand related to emotional stress. The former requires aggressive medical or surgical therapy; the latter, a demand-induced angina, responds to beta-adrenergic blockade and a tranquilizer.