Stress and Acute Coronary Syndrome

A plethora of risk factors, such as hypercholesterolemia, smoking, hypertension, and others lead to the progression of coronary atherosclerosis. Vulnerable plaques are formed, and rupture of such plaques results in the development of myocardial infarction. Great progress has been made in the medical community's focus on management of risk factors, with clear improvement in the incidence and outcome of myocardial infarction. However, triggers of plaque rupture, which include significant physical and mental stress, need more attention. In this report, we focused on the effect of emotional stress in triggering various acute cardiac events. Natural disasters such as earthquakes result in significant emotional stress, and have been associated with substantial increases in cardiac death and acute myocardial infarction. This is more pronounced with severe events, particularly if they occur in the early morning hours. Anger and severe emotional stress from various life events, particularly from stressed marital relations or stressful working conditions, will result in markedly increased occurrence of myocardial infarction. This is more pronounced in patients with known coronary artery disease or significant risk factors. Providers need to focus on management of stress during hospitalization for myocardial infarction, as well as in the rehabilitation phase of such events.