Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Physical Activity or Anger as Triggers for Acute MI

Circulation; 2016 Oct 11; Smyth, et al

Publish date:

First acute myocardial infarction (AMI) is triggered by physical exertion and anger, or emotional upset in both men and women in all age groups, a recent study found. INTERHEART is a case-control study of first AMI in 52 countries that included 12,461 cases of AMI. Researchers found:

  • 13.6% (n=1,650) engaged in physical activity and 14.4% (n=1,752) were angry or emotionally upset in the case period (1 hour before symptom onset).
  • There were increased odds of AMI (OR, 2.31) with a population-attributable risk of 7.7% among participants who had engaged in physical activity in the case period.
  • Anger or emotional upset in the case period was associated with increased odds of AMI (OR, 2.44) with a population-attributable risk of 8.5%.
  • Both physical activity and anger or emotional upset in the case period were associated with a further increase in the odds of AMI (OR, 3.05).

Citation:

Smyth A, O’Donnell M, Lamelas, et al. Physical activity and anger or emotional upset as triggers of acute myocardial infarction. Circulation. 2016;134:1059-1067. doi:10.1161/CIRCULATIONAHA.116.023142.

Commentary:

We typically think of exertion as a major trigger for angina and AMI. This study confirms what we also believe, and what poets have written about for a millennium, that emotions can trigger pain of the heart. In over 8% of patients with AMI, according to this study, emotional discomfort may be the primary trigger. We know that emotional reactions can cause sympathetic activation, systemic vasoconstriction, increased heart rate and increased blood pressure. It makes sense that it is an important contributor to myocardial infarctions. —Neil Skolnik, MD

This Week's Must Reads

Must Reads in Cardiology