The link between mental stress psychiatric

The link between mental stress, psychiatric illness and cardiovascular disease, although best established for heart disease consequential to acute mental stress and depressive illness, has been much more difficult to establish.26 Acute mental stress can trigger sympathetic outflow to the heart and adrenal secretion of epinephrine. In patients with pre-existing atherosclerosis, not only can increased MI-773 cause ventricular arrhythmias (especially in the presence of coronary artery stenosis), but the attendant BP surge can fissure coronary plaques and promote platelet aggregation, predisposing to thrombosis.26 Takotsubo (stress) cardiomyopathy is a good example of extreme acute activation of cardiac sympathetic outflow to the heart,26 as are panic attacks accompanied by coronary spasm and cardiac arrhythmias.33 In patients with depressive illness, chronic cardiac sympathetic outflow is at almost the same level as seen in patients with heart failure, and is accepted as a primary cause for heart disease, associated with a worse prognosis.