Cardiovascular consequences of anger and other stress states.

Abstract

Anger is the affective state most commonly associated with myocardial ischaemia and infarction and life-threatening arrhythmias, with at least 36,000 (2.4% of 1.5 million) heart attacks precipitated annually by anger in the United States. Fear, anxiety and bereavement are also implicated in increased vulnerability to cardiac events. The lethal cardiovascular consequences of these behavioural stress states in patients with ischaemic heart disease are attributable to activation of high-gain central neurocircuitry and the sympathetic nervous system, provoking acute sinus tachycardia, hypertension, impaired myocardial perfusion and cardiac electrical instability. The fields of epidemiology, behavioural medicine and cardiovascular physiology have generated new methodologies for studying the pathophysiology of anger and other behavioural stress states with the goal of developing means to sever the link between the anger and its life-threatening consequences.