Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Saturated fat and cardiovascular disease wikipedia , lookup
Electrocardiography wikipedia , lookup
Cardiovascular disease wikipedia , lookup
Jatene procedure wikipedia , lookup
Arrhythmogenic right ventricular dysplasia wikipedia , lookup
Quantium Medical Cardiac Output wikipedia , lookup
Management of acute coronary syndrome wikipedia , lookup
Dextro-Transposition of the great arteries wikipedia , lookup
PSYCHOLOGICAL STRESS ACUTE PSYCHOLOGICAL STRESS Confront a Bear arouses Fear elicits Adaptive Responses Cardiovascular Responses heart rate, contractile force Preparatory and serve to increase cardiac output to supply additional blood to skeletal muscles BEAR Sudden Cardiac Death EMOTION AND SUDDEN CARDIAC DEATH BIBLE - BOOK of ACTS When Ananias was charged by Peter “you have not lied to man but to God,” he fell dead; as did Sapphira, his wife, when told that “the feet of them which have buried thy husband are at the door and shall carry thee out” George Engel (1971). Life Settings in which Sudden Death Occurred • On impact of the collapse and death of a loved one (21%) • During acute grief (20%) • Threat of loss of a loved one (9%) • During mourning or anniversary of death of loved one (3%) • Loss of status or self-esteem (6%) • Personal danger or threat of injury (27%) • After the danger is over (7%) Engel - (cont) • Reunion, triumph or happy ending (6%) Common Thread - Events were impossible for the victims to ignore. Trichopoulus et al. 1983. Psychological stress and the fatal heart attack: the Athens (1981) earthquake natural experiment. Trichopoulus et al. - 1983 • • • • • • February 24-11:00 p.m. Earthquake February 25 February 26 February 27 Aftershocks February 28 March 1 Trichopoulus et al. - (cont.) • Death Certificates at time of earthquake • Death Certificates from Control Periods 1980, 1981,1982 • Immediate cause of death due to sudden cardiac event Trichopoulus et al. - Results • Daily Number of Deaths due to Cardiac Event • Control Period Mean = 7.1 • Quake Period: Feb. 25 = 9 Feb. 26 = 11 Feb. 27 = 14 Mean = 10.4 Feb. 28 = 9 Mar. 1 = 9 Meisel et al. (1991). Effect of Iraqi missile war on incidence of acute myocardial infarction and sudden death in Israeli Civilians. Meisel et al.(1991) • Gulf War SCUD Missile attacks on Tel Aviv. • Sapir Medical Center • First week of the war – Jan. 17-25, 1991 - Number of patients who were seen/died from acute myocardial infarction (heart attack) - Compared to number of patients during control periods Meisel et al.,(1991)- Results Sapir Medical Center Patients Seen* Out of hospital Sudden Deaths n = 41 First week of the war n = 22 Jan. 17-25, 1990 Loer et al. (1996). Sudden death triggered by an Earthquake The Northridge, California earthquake Kawachi et al. (1994). Prospective study of phobic anxiety and risk of coronary heart disease in men. Kawachi et al.(1994) • • 1. 2. 3. 4. 5. Studied 2000 men from 1961 to 1993 1961 – Physical exam Questionaire – Five Questions Do strange people or places make you afraid? Are you considered to be a nervous person? Are you constantly keyed-up or jittery? Do you often become scared for no good reason? Do you often break out in a cold sweat? QUESTIONAIRE RESULTS - 89% scored a 0, 8.9% scored a 1, 1.9% scored a 2 or more. Kawachi et al. (1994) – cont. • From 1961- 1993 1. Every three years - Medical history - Physical exams - Lab tests 2. Cause of death monitored in deceased men • RESULTS – Those men who scored a 2 or higher on the questionaire were 4 times more likely to die of sudden cardiac death than those who scored a 0. That is, phobic anxiety is a risk factor for sudden cardiac death. Acute Psychological Stress Ventricular Arrhythmias (abnormal heart beats) Ventricular Fibrillation Sudden Death Predisposition to Electrical Instability Digitalis • Used to increase contractile force of the heart • Can cause arrhythmias at high doses Amygdala Cardioregulatory Nuclei (Medulla) Heart Chronic Stress ? Cardiovascular Disease • Cardiovascular Stress Response 1. Cardiac Output - heart rate contractile force 2. Changes in Blood Vessels - constriction produces blood pressure 3. Changes in blood flow - constriction of vessels to skin, kidney, viscera - dilation of vessels in skeletal muscles PSYCHOSOCIAL STRESS AND ATHEROSCHLEROSIS • Jay Kaplan – 1980’s ff - cynomolgus monkeys - in the wild - mixed gender groups - all male groups - intrusions during the mating season Kaplan et al. – Experiment 1 22 months duration 1. Unstable Social Condition - Three groups of males - n=5 per group - Every 1-3 months Redistribution Each male is placed with 3-4 new males 2. Stable Social Condition - Three groups of males - No redistribution UNSTABLE SOCIAL CONDITION N=5 N=5 N=5 Redistribution every 1-3 months Each male with 3 to 4 new males STABLE SOCIAL CONDITION N=5 N=5 No Redistribution N=5 Kaplan et al. - Experiment 1(cont.) • Fed a “North American Diet” - moderately atherogenic (high fat, high cholesterol) • Routine evaluations - Pathological Observations - blood lipids, blood pressure, heart rate - Behavioral Observations - fighting behavior - patterns of dominance • Measured coronary artery atheroschlerosis - at 22 months Kaplan et al.- Expt.1 RESULTS • When compared to subordinates, dominant monkeys in unstable condition show a. Increased heart rates b. Increased atheroschlerotic lesions* • No difference in atheroschlerosis and heart rates between subordinate and dominant monkeys in stable condition Is the increased atheroschlerosis due to increased sympathetic nervous system activation? Kaplan et al. - Experiment 2 • Male monkeys • 22 months • Unstable social condition - Two Drug Conditions a. Norepinephrine Beta receptor antagonist group propranolol = antagonist b. Placebo control group Kaplan et al.- Experiment 2 Results • Propranolol inhibited the development of atheroschlerosis in dominant monkeys. • Propranolol had no effect on subordinate monkeys. Kaplan et al. - Conclusions Psychosocial Stress activate Sympathetic Nervous System produces Atheroschlerosis How does sympathetic nervous system innervation of the vascular system produce atheroschlerosis? Blood Vessels Bifurcations Bends Increased Force Increased Turbulence Increased Wear and Tear Mechanics of Wear 1. Smooth inner lining of vessel tears and scars 2. Fatty acids and glucose work their way under the layer and stick there thickening plaques Green = Atheroschler. plaque Adrenal Glands Norepinephrine Epinephrine released with stress Glucose, Fatty acids Gender Differences in Development of Atheroschlerosis in Humans • Expression of atheroschlerosis is delayed in females by 10-15 years • What contributes to this delayed onset? Kaplan et al. - Experiment 3 • Female monkeys • Male monkeys - n=5-6 in stable social groups for 24 months • Evaluation of ovarian function in females - measurements of progesterone levels • RESULTS: Subordinate females - enlarged adrenal glands* - impaired ovarian function* - greater incidence of atheroschlerosis* Dominant Subordinate Progesterone levels Luteal phase of ovulatory cycle 8.89 ng/ml 3.79 ng/ml Adrenal weights 168 mg/kg 201 mg/kg Percentage cycles with luteal phase deficiencies 8.9 24.3 Does Impaired Ovarian Function Contribute to Atheroschlerosis? Kaplan et al. - Experiment 4 • 24 months • Ovarectomized females • RESULTS : - Ovarectomy increased atheroschlerosis in dominant but not subordinate females • CONCLUDE: - Ovarian hormones are anti-atheroschlerotic Kaplan et al. Expt 4. – cont. Stress of Social Subordination Impairment of Ovarian Function Increased Risk of Atheroschlerosis Kaplan et al. Experiment 5 • • • • Exogenous estrogen treatment to female monkeys Triphasil=exogenous estrogen Measured iliac artery atheroschlerosis RESULTS: - triphasil protected subordinate females* - in control group, the more dominant the monkey, the less the atheroschlerosis* Sparing of coronary heart disease in pre-menopausal women compared to men • Delay of disease onset in women CHD Death Rate – 40 year olds Men 40 per 100,000/yr 5:1 Women 8 per 100,000/yr Men Women CHD Death Rate – 60 yr olds 400 per 100,000/yr 2:1 175 per 100,000/yr