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Coronary Risk Factors: The Contemplation of Bigamy

Martin S. Gizzi, PhD, MD; Bernard Gitler, MD
JAMA. 1986;256(9):1138. doi:10.1001/jama.1986.03380090066018.
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To the Editor.—  In the search to identify risk factors for atherosclerosis and myocardial infarction, physicians since Osler1 have been aware of the importance of psychological stress. The Western Collaborative Group Study2 convincingly identified coronary-prone type A behavior, and more recent studies have concentrated on psychological stress as a risk factor.3,4 Two cases we have seen in our coronary care unit exhibited a striking similarity that we feel singles out a particular source of stress as a contributing factor to myocardial infarction.

Report of Case.—  The first patient was a 53-year-old man who 11 years before had undergone coronary artery bypass surgery and who presented with angina that proved to be caused by an acute myocardial infarction. On the morning after admission he was visited by his wife in the coronary care unit. Shortly after her departure he was visited by his fiancee. The patient died shortly


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