Yale researchers have found that psychological stress can facilitate sudden death by increasing the chances that arrhythmias -- abnormal heart rhythms -- are more lethal in susceptible patients.
These kinds of deaths, says Dr. Rachel Lampert, the study's lead investigator, also happen more often on Mondays, in the morning, and during disasters such as earthquakes and in war.
"In patients with a history of known susceptibility to arrhythmias, mental stress can induce faster arrhythmias which are more difficult to treat than those occurring without a stressful situation," says Lampert, who is assistant professor of medicine in the Section of Cardiology at the School of Medicine. "This shows that mental stress alters the behavior of arrhythmia circuits, making them more deadly."
Published in Circulation, a journal of the American Heart Association, the two-year study looked at patients with implantable cardioverter-defibrillators. To mimic mental stress, researchers asked patients to discuss upsetting or frustrating situations. All the studies were carried out in the morning after an overnight fast. Each patient underwent non-invasive programmed stimulation in three conditions: resting-awake, mental arithmetic and anger recall. Patients also underwent mental stress during testing of their defibrillators.
"We found that arrhythmias brought on during stress were faster and harder to terminate than those brought on at rest," says Lampert. "We did not see evidence of lack of blood flow to the heart. This suggests that the changes were due to shifts in the heart's electrical system caused by stress."
Lampert's team will soon begin to study the clinical implications of their findings. They will seek answers to questions such as: Does responsiveness to the mental stress in the laboratory setting predict future arrhythmias? Can we use mental stress as a way of identifying patients at risk for arrhythmias?
They will also take measurements of the heart, nervous system and brain function while looking at stress-induced changes in arrhythmias.
Lampert's research team at Yale included Dr. Diwaker Jain, Dr. Matthew M. Burg, Dr. William P. Batsford and Dr. Craig A. McPherson.
-- By Karen Peart
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