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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
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 “thefeet of them which have buried thy husbandare 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
Kawachi et al. (1994). Prospective study of phobic anxiety and risk of coronary
heart disease in men.
Kawachi et al.(1994)
• Studied 2000 men from 1961 to 1993
• 1961 – Physical exam
Questionaire – Five Questions
1. Do strange people or places make you afraid?
2. Are you considered to be a nervous person?
3. Are you constantly keyed-up or jittery?
4. Do you often become scared for no good reason?
5. 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
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 122 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 monthsEach male with 3 to 4 new males
N=5 N=5 N=5
No Redistribution
STABLE SOCIAL CONDITION
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
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
Mechanics of Wear
1. Smooth inner lining of vessel tears and scars2. 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
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*