Journal ArticleDOI
Neural and psychologic mechanisms and the problem of sudden cardiac death
TLDR
Environmental stresses of diverse types can injure the heart, lower the threshold of cardiac vulnerability to ventricular fibrillation and, in the animal with coronary occlusion, provoke potentially malignant ventricular arrhythmias.Abstract:
Brain stimulation can provoke a variety of arrhythmias and lower the ventricular vulnerable threshold. In the animal with acute myocardial ischemia such stimuli suffice to provoke ventricular fibrillation. Vagal neural traffic or adrenal catecholamines are not the conduits for this brain-heart linkage. Accompanying increases in heart rate or blood pressure are not prerequisites for the changes in cardiac excitability. Increased sympathetic activity, whether induced by neural or neurohumoral action, predisposes the heart to ventricular fibrillation. Protection can be achieved with surgical and pharmacologic denervation or reflex reduction in sympathetic tone. With acute myocardial ischemia, augmented sympathetic activity accounts for the early surge of ectopic activity frequently precipitating ventricular fibrillation. Asymmetries in sympathetic neural discharge may also contribute to the genesis of serious arrhythmias. The vagus nerve, through its muscarinic action, exerts an indirect effect on cardiac vulnerability, the consequence of annulment of concomitant adrenergic influence, rather than of any direct cholinergic action on the ventricles. There exist anatomic, physiologic as well as molecular bases for such interactions. Available experimental evidence indicates that environmental stresses of diverse types can injure the heart, lower the threshold of cardiac vulnerability to ventricular fibrillation and, in the animal with coronary occlusion, provoke potentially malignant ventricular arrhythmias. Available evidence indicates that in man, as in the experimental animal, administration of catecholamines can induce ventricular arrhythmia, whereas vagal activity exerts an opposite effect. Furthermore, in certain subjects diverse stresses and various psychologic states provoke ventricular ectopic activity.read more
Citations
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Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy.
TL;DR: Suggestions to improve the assessment of behavioral interventions include more complete delineation of the physiological mechanisms by which such interventions might work; increased use of new, more convenient "alternative" end points for behavioral intervention trials; development of specifically targeted behavioral interventions (based on profiling of patient factors); and evaluation of previously developed models of predicting behavioral change.
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The clinical application of the biopsychosocial model
TL;DR: The implications of the biopsychosocial model for the study and care of a patient with an acute myocardial infarction are presented and contrasted with approaches used by adherents of the more traditional biomedical model.
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Diabetic Autonomic Neuropathy
TL;DR: There are studies in progress that suggest that autonomic nerves can be induced to regenerate, and the future for patients with diabetic autonomic neuropathy is brighter.
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The Clinical Application of the Biopsychosocial Model
TL;DR: The implications of the biopsychosocial model for the study and care of a patient with an acute myocardial infarction are presented and contrasted with approaches used by adherents of the more traditional biomedical model.
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Psychosocial influences on mortality after myocardial infarction.
TL;DR: The increase in risk associated with stress and social isolation applied both to total deaths and to sudden cardiac deaths and was noted among men with both high and low levels of ventricular ectopy during hospitalization for the acute infarction.
References
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Journal ArticleDOI
Approaches to Sudden Death from Coronary Heart Disease
Bernard Lown,Marshall A. Wolf +1 more
TL;DR: Since it is likely that SCD is due to an arrhythmia, drug prophylaxis might prove effective and it is mandatory to preselect a population at highest risk before embarking on a drug trial.
Journal Article
The relation of adenosine-3', 5'-phosphate and phosphorylase to the actions of catecholamines and other hormones
Earl W. Sutherland,T. W. Rall +1 more
Journal ArticleDOI
The long Q-T syndrome.
TL;DR: The possiblity for the correctly diagnosed and treated patients to escape an otherwise impending death calls urgently for diffusion of the knowledge about the long Q-T syndrome.
Journal ArticleDOI
Sympathetic-parasympathetic interactions in the heart.
TL;DR: It is generally recognized that the two divisions of the autonomic nervous system exert antagonistic efFects on various aspects of the performance of the heart; these opposing influences are not algebraically additive; complicated interactions exist.
Journal ArticleDOI
Neural activity and ventricular fibrillation.
Bernard Lown,Richard L. Verrier +1 more
TL;DR: In this country, ventricular fibrillation is the likely mechanism for sudden death and the leading cause of fatality among patients with coronary heart disease.