Acute Psychological Stress as a Precipitant of Acute Coronary Syndromes in Patients With Undiagnosed Ischemic Heart Disease: A Case Report and Literature Review

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Objective: Acute psychological stress causes a number of physiologic responses that can trigger acute coronary syndromes in individuals with silent coronary artery disease. The mechanisms behind this phenomena have been the subject of much speculation. The following is a case report and brief review of the literature.

Method: A PubMed search was undertaken using the key words stress and myocardial infarction, stress and ischemia, mental stress and coronary artery disease, psychological stress and acute coronary syndrome, and mental stress and plaque destabilization. Articles were restricted to the English language and those dating through December 2007.

Results: Acute coronary syndrome is thought to be the end result of a complex mechanism involving platelet activation and endothelial dysfunction. Several studies have shown that acute mental stress leads to enhanced platelet activation and endothelial dysfunction. The mechanism behind this involves both the autonomic nervous system and the neuroendocrine response.

Conclusions: Acute psychological stress may lead to acute coronary syndromes in patients with previously silent disease. Physicians should inquire about cardiac symptoms in patients with cardiac risk factors who are experiencing psychological distress. Further research will hopefully lead to an improved understanding of the mechanism behind this process to improve therapeutic interventions.

Prim Care Companion J Clin Psychiatry 2009;11(1):21-24