Acute myocardial infarction triggered by acute intense stress in a patient with panic disorder

Psychosocial stresses are associated with an increased risk for acute myocardial infarction (AMI). We report a 35-year-old male patient who developed AMI after acute psychological trauma. He presented with chest pain that began after being involved in a fight. He was extremely agitated. He did not have any risk factors for coronary disease except for panic disorder which was diagnosed six years before. Cardiac enzymes were found elevated. His electrocardiogram (ECG) showed ST-segment elevation in leads V2-6. After thrombolytic therapy with tissue plasminogen activator, his chest pain relieved and ST elevations on ECG regressed. Coronary angiography showed normal coronary arteries. Acute extraordinary stress may be responsible for AMI in this young patient as a result of sympathetic hyperactivity and coronary vasospasm.