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Terrorism and the Heart: Implications for Arrhythmogenesis and Coronary Artery Disease

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Cardiac Electrophysiology Review

Abstract

The destruction of the World Trade Center and associated terrorist activities of September 11, 2001 have spurred interest in understanding the medical consequences of terrorist activity. Currently, there is a paucity of data regarding this subject. Potential effects, however, can be garnered by studying the medical effects of other acute stressors, such as earthquakes, missile attacks, and the like. None of these stressors have been studied extensively, but there is enough data available concerning earthquakes to indicate that in some instances, the effects of the earthquake may last at least a period of weeks, if not months, following the earthquake. Since the World Trade Center attack was associated with a rise in post-traumatic stress syndrome and affective disorders afterwards, there is accordingly interest in both the acute and more prolonged health effects that could be engendered following terrorist attacks.

Known pathophysiological effects of acute stress, whether produced in a laboratory environment or by studying naturally occurring acute stressors, include: the induction or potentiation of cardiac arrhythmias; the induction of myocardial ischemia in susceptible patients with underlying coronary artery disease; acute increases in arterial blood pressure with its ability to cause shear stress; the precipitation of worsening endothelial function and/or endothelial injury; coagulation abnormalities; and hemoconcentration. These all represent important areas for study following the occurrence of future terrorist activity.

Based on existing epidemiological and pathophysiological data concerning the cardiac effects of acute life stressors, it would behoove physicians to closely monitor high-risk cardiac patients following future terrorist events. In addition, physician-scientists should be well prepared to use new epidemiological markers which could provide rapid information following future events, such as the evaluation of patients using pre-versus post-event serum markers or tracing records available among patients fitted with implantable cardiovertor-defibrillators.

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References

  1. Meisel SR, Kutz I, Dayan KI, Pauzner H, Chetboun I, Arbel Y, David D. Effects of Iraqi missilewar on incidence of acute myocardial infarction and sudden death in Israeli civilians. Lancet 1991; 338: 660-661.

    Google Scholar 

  2. Leor J, Poole WK, Kloner RA. Sudden cardiac death triggered by an earthquake. N Engl J Med 1996; 334: 413-419.

    Google Scholar 

  3. Dobson AK, Alexander HM, Malcolm JA, Steele PL, Miles TA. Heart attacks and the Newcastle earthquake. Med J Aust 1991; 155: 757-761.

    Google Scholar 

  4. Trichopoulos D, Katsouyanni K, Zavitsanos X, Tzonou A, Dalla-Vorgia P. Psychological stress and fatal heart attack: The Athens (1981) earthquake natural experiment. Lancet 1983; 1: 441-444.

    Google Scholar 

  5. Suzuki S, Sakamoto S, Kiki T, Matsuo T. Hanshin-Awaji earthquake and acute myocardial infarction. Lancet 1995; 345: 981.

    Google Scholar 

  6. Kario K, Matsuo T, Kobayashi H, Yamamoto K, Shmiada K. Earthquake-induced potentiation of acute risk factors in hypertensive elderly patients: Possible triggering of cardiovascular events after a major earthquake. J Am Coll Cardiol 1997; 29: 926-933.

    Google Scholar 

  7. Suzuki S, Sakamoto S, Koide M, Kiki T, Matsuo T. Hanshin-Awaji earthquake as a trigger for acute myocardial infarction. Am Heart J 1997; 134: 974-977.

    Google Scholar 

  8. Kaprio J, Koskenvuo M, Rita H. Mortality after bereavement: A prospective study of 95,647 persons. Am J Public Health 1987; 77: 283-287.

    Google Scholar 

  9. Parkes CM. Effects of bereavement on physical and mental health: A study of the medical records of widows. Br Med J 1964; 2: 274-279.

    Google Scholar 

  10. Engel GL. Sudden and rapid death during psychological stress: Folklore or folk wisdom? Ann Intern Med 1971; 74: 771-782.

    Google Scholar 

  11. Greene WA, Goldstein S, Moss AJ. Psychosocial aspects of sudden death: A preliminary review. Arch Intern Med 1972; 129: 725-731.

    Google Scholar 

  12. Myers A, Dewar HA. Circumstances attending 100 sudden deaths from coronary artery disease with coroner's necropsies. Br Med J 1975; 37: 1133-1143.

    Google Scholar 

  13. Sadavoy J. Survivors: A review of the late life effects of prior psychological trauma. Am J Ger Psychiatry 1997; 5: 287-301.

    Google Scholar 

  14. Schwarz ED, Kowalski JM. Malignant memories: PTSD in children and adults after a school shooting. J Am Acad Child & Adolescent Psychiatry1991; 30: 936-944.

    Google Scholar 

  15. Lown B, Verrier RL, Corbalan R. Psychologic stress and threshold for repetitive ventricular response. Science 1973; 182: 834-836.

    Google Scholar 

  16. Verrier RL, Hagestad EL, Lown B. Delayed myocardial ischemia induced by anger. Circulation 1987; 75: 249-254.

    Google Scholar 

  17. Verrier RL, Lown B. Behavioral stress and cardiac arrhythmias. Annu Rev Physiol 1984; 46: 155-176.

    Google Scholar 

  18. Tavazzi L, Zotti M, Rondanell R. The role of psychological stress in the genesis of lethal arrhythmias in patients with coronary artery disease. Euro Heart J 1986; 7: 99-106.

    Google Scholar 

  19. Lampert R, Jain D, Burg MM, Batsford WP, McPherson CA. Destabilizing effects of mental stress on ventricular arrhythmia in patients with implantable cardiovertordefibrillators. Circulation 2000; 101: 158-164.

    Google Scholar 

  20. Peters RW, McQuillan S, Resnick SK, Gold MR. Increased Monday incidence of life-threatening ventricular arrhythmias: Experience with a third-generation implantable de-fibrillator. Circulation 1996; 94: 1346-1349.

    Google Scholar 

  21. Lampert R, Joska T, Burg MM, Burg M, Batsford W, McPherson CA, Jain D. Emotional and physical perceptions of ventricular arrhythmia. Circulation 2002; 106: 1800-1805.

    Google Scholar 

  22. Galea S, Ahern J, Rensnick H, Kilpatrick D, Bucuvalas M, Gold J, Vlahov D. Psychological sequelae of the September 11 terrorist attacks in New York City. New Engl J Med 2002; 346: 982-987.

    Google Scholar 

  23. Schuster MA, Stein BD, Jaycox L, Collins RL, Marshall GN, Elliott MN, Zhou AJ, Kanouse DE, Morrison JL, Berry SH. A national survey of stress reactions after the September 11, 2001, terrorist attacks. New Engl J Med 2001; 345: 1507-1512.

    Google Scholar 

  24. Silver RC, Holman EA, McIntosh DN, Poulin M, Gil-Rivas V. Nationwide longitudinal study of psychological responses to September 11. JAMA 2002; 288: 1235-1244.

    Google Scholar 

  25. Lampert R, Baron S, McPherson C, Lee FA. Long reaching effects of terrorism: Altered heart rate variability during and after September 11, 2001. PACE 2002; 24: 630 ( abstract 429).

    Google Scholar 

  26. Rozanski A, Bairey CN, Krantz DS, Friedman J, Resser KJ, Morell M, Hilton-Chalfen S, Hestrin L, Bietendorf J, Berman DS. Mental stress and the induction of silent myocardial ischemia in patients with coronary artery disease. N Engl J Med 1988; 318: 1005-1012.

    Google Scholar 

  27. Goldberg AD, Becker LC, Bonsall R, Cohen JD, Ketterer MW, Kaufman PG, Krantz DS, Light KC, McMahon RP, Noreuil T, Pepine CJ, Raczynski J, Stone PH, Strother D, Taylor H, Sheps DS. Ischemic, hemodynamic, and neurohormonal responses to mental and exercise stress: Experience from the psychophysiological investigations of myocardial ischemia study (PIMI). Circulation 1996; 94: 2402-2409.

    Google Scholar 

  28. Deanfield JE, Shea M, Kensett M, Horlock P, Wilson RA, Landsheere CMD, Selwyn AP. Silent myocardial ischemia due to mental stress. Lancet 1984; 2: 1001-1004.

    Google Scholar 

  29. Giubbini R, Galli M, Campini R, Bosimini E, Bencivelli W, Tavazzi L. Effects of mental stress on myocardial perfusion in patients with ischemic heart disease. Circulation 1991; 83(suppl II): 100-107.

    Google Scholar 

  30. Gottdiener JS, Krantz DS, Howell RH, Hecht GM, Falconer JJ, Rozanski A. Introduction of silent myocardial ischemia with mental stress testing: Relation to the triggers of ischemia during daily life activities and to ischemic functional severity. J Am Coll Cardiol 1994; 24: 1645-1651.

    Google Scholar 

  31. Yeung AC, Vekshtein VI, Krantz DS, Vita JA, Ryan TJ, Ganz P, Selwyn AP. The effect of atherosclerosis on the vasomotor response of the coronary arteries to mental stress. N Engl J Med 1991; 325: 1551-1556.

    Google Scholar 

  32. Dakak N, Quyyumi AA, Eisenhofer G, Goldstein DS, Cannon RO III. Sympathetically mediated effects of mental stress on the cardiac microcirculation of patients with coronary artery disease. Am J Cardiol 1995; 76: 125-130.

    Google Scholar 

  33. Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and the implications for therapy. Circulation 1999; 99: 2192-2217.

    Google Scholar 

  34. Jern C, Eriksson E, Tengborn L, Risberg B, Wadenvik H, Jern S. Changes of plasma coagulation and fibrinolysis in response to mental stress. Thromb Haemost 1989; 62: 767-771.

    Google Scholar 

  35. Grignani G, Soffiantino F, Zucchella M, Pacchiarini L, Tacconi F, Bonomi E, Pastoris A, Sbaffi A, Fratino P, Tavazzi L. Platelet activation by emotional stress in patients with coronary artery disease. Circulation 1991; 83(suppl II): II-128-II-136.

    Google Scholar 

  36. Levine SP, Towell BL, Suarez AM, Knieriem LK, Harris MM, George JN. Platelet activation and secretion associated with emotional stress. Circulation 1985; 71: 1129-1134.

    Google Scholar 

  37. Muldoon MF, Bachen EA, Manuck SB, Waldstein SR, Bricker PL, Bennett JA. Acute cholesterol responses to mental stress and change in posture. Arch Intern Med 1992; 152: 775-780.

    Google Scholar 

  38. Allen MT, Patterson SM. Hemoconcentration and stress: A review of physiological mechanisms and relevance for cardiovascular disease risk. Biol Psychol 1995; 41: 1-27.

    Google Scholar 

  39. Urano T, Malyszko J, Serizawa K, Kojirna Y, Takada Y, Takada A. Electric-foot-shock induced the suppression of fibrinolytic activity in rats. Thromb Res 1994; 74: 595-603.

    Google Scholar 

  40. Lowe GDO, Lee AJ, Rumley A, Price JF, Fowkes FGR. Blood viscosity and risk of cardiovascular event: The Edinburgh artery study. Br J Haematol 1997; 96: 168-173.

    Google Scholar 

  41. Ghiadoni L, Donald AE, Cropley M, Mullen MJ, Oakley G, Taylor M, Deanfield JE. Mental stress induced transient endothelial dysfunction in humans. Circulation 2000; 102: 2473-2478.

    Google Scholar 

  42. Spieker L, Hürlimann D, Ruschitzka F MD, Corti R, Enseleit F, Shaw S, Hayoz D, Deanfield JE, Lüscher TF, Noll G. Mental stress induces prolonged endothelial dysfunction via endothelin-A receptors. Circulation 2002; 105: 2817-2820.

    Google Scholar 

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Authors and Affiliations

  1. Divisions of Cardiology, Departments of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, USA;

    Ehtasham A. Qureshi, Veeranna Merla, Jonathan Steinberg & Alan Rozanski

  2. The Lankenau Hospital, Wynnewood, Pennsylvania, USA

    Ehtasham A. Qureshi

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  1. Ehtasham A. Qureshi
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  2. Veeranna Merla
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Qureshi, E.A., Merla, V., Steinberg, J. et al. Terrorism and the Heart: Implications for Arrhythmogenesis and Coronary Artery Disease. Card Electrophysiol Rev 7, 80–84 (2003). https://doi.org/10.1023/A:1023607527038

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