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April 17, 1987, Vol 257, No. 15 >
ARTICLE | April 17, 1987

Ventricular Tachyarrhythmia Associated With Psychological Stress: Title and subTitle BreakThe Role of the Sympathetic Nervous System FREE

Michael A. Brodsky, MD; David A. Sato, MD; Lloyd T. Iseri, MD; Larry J. Wolff, MD; Byron J. Allen, MD
[+] Author Affiliations

Reprint requests to University of California at Irvine, Medical Center, 101 City Dr S, Orange, CA 92668 (Dr Brodsky).


JAMA. 1987;257(15):2064-2067. doi:10.1001/jama.1987.03390150080039
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References

Psychological stress has been reported to be a risk factor for sudden cardiac death in individuals both with and without underlying structural heart disease. From a group of 80 patients presenting with life-threatening ventricular tachyarrhythmia, six were identified without underlying structural heart disease. Five of these six patients experienced marked psychological stress. Each of these five patients underwent arrhythmia evaluation, demonstrating recurrent rapid monomorphic ventricular tachycardia related to changes in tone of the sympathetic nervous system. Subsequently, solitary β-adrenergic blocker therapy was given to each patient. During therapy, four of the five patients had a marked reduction of both arrhythmia and symptoms during a follow-up ranging from 29 to 49 (mean, 38) months.

(JAMA 1987;257:2064-2067)

REFERENCES

1 +
Cannon SB:  Voodoo death . Am Anthropol 1942;;44:169-181.
2 +
Engle GL:  Sudden and rapid death during psychological stress . Ann Intern Med 1971;;74:771-782.
3 +
Rahe RH, Romo M, Bennett L, et al:  Recent life changes, myocardial infarction, and abrupt coronary death . Arch Intern Med 1974;;133:221-228.
4 +
Myers A, Dewar HA:  Circumstances attending 100 sudden deaths from coronary artery disease with coroner's necropsies . Br Heart J 1975;;37:1133-1143.
5 +
Lown B, Temte JV, Reich P, et al:  Basis for recurring ventricular fibrillation in the absence of coronary heart disease and its management . N Engl J Med 1976;;294:623-629.
6 +
Trichopolus D, Katsouyanni K, Zavitsanos X, et al:  Psychological stress and fatal heart attack: The Athens (1981) earthquake natural experiment . Lancet 1983;;1:441-444.
7 +
Harvey WP, Levine SA:  Paroxysmal ventricular tachycardias due to emotion: Possible mechanism of death from fright . JAMA 1951;;150:479-480.
8 +
Reich P, DeSilva RA, Lown B, et al:  Acute psychological disturbances preceding life-threatening ventricular arrhythmias . JAMA 1981;;246:223-235.
9 +
Lown B, Verrier RL, Rabinowitz SH:  Neural and psychologic mechanisms and the problem of sudden cardiac death . Am J Cardiol 1977;;39:890-902.
10 +
Skinner JE, Lie JT, Entman ML:  Modification of ventricular fibrillation latency following coronary artery occlusion in the conscious pig: The effects of psychological stress and β-adrenergic blockade . Circulation 1975;;51:657-667.
11 +
Levine SA, Woodworth CR:  Congenital deaf-mutism, prolonged QT interval, syncopal attacks and sudden death . N Engl J Med 1959;;259:412-417.
12 +
Wellens HJJ, Vermeulen A, Durrer D:  Ventricular fibrillation occurring on arousal from sleep by auditory stimuli . Circulation 1972;;46:661-665.
13 +
Frank JP, Friedenberg DZ:  Syncope with prolonged QT interval . AJDC 1976;;130:320-322.
14 +
Gettes LS, Surawicz B:  Long-term prevention of paroxysmal arrhythmias with propranolol therapy . Am J Med Sci 1967;;254:257-265.
15 +
Coumel P, Fidelle J, Lucet V, et al:  Catecholamine-induced severe ventricular arrhythmias with Adams-Stokes syndrome in children: Report of four cases . Br Heart J 1978;;40:28-37.
16 +
Woosley RL, Kornhauser D, Smith R, et al:  Suppression of chronic ventricular arrhythmias with propranolol . Circulation 1979;;60:820-826.
17 +
Wu D, Kou HC, Hung JS:  Exercise-triggered paroxysmal ventricular tachycardia: A repetitive rhythmic activity possibly related to afterdepolarization . Ann Intern Med 1981;;95:410-414.
18 +
Brodsky MA, Sato DA, Allen BJ, et al:  Solitary β-blocker therapy for idiopathic life-threatening ventricular tachyarrhythmias . Chest 1986;;89:790-794.
19 +
Lown B, Tykocinski M, Garfein A, et al:  Sleep and ventricular premature beats . Circulation 1973;;48:691-701.
20 +
Taggart P, Carruthers M, Somerville W:  Electrocardiogram, plasma catecholamines and lipids and their modification by oxprenolol when speaking before an audience . Lancet 1973;;2:341-345.
21 +
Bernadt MW, Silverstone T, Singleton W:  Behavioral and subjective effects of β-adrenergic blockade in phobic subjects . Br J Psychiatry 1980;; 137:452-457.
22 +
Wilson FN, Wishart SW, Macleod AG, et al:  A clinical type of paroxysmal tachycardia of ventricular origin in which paroxysms are induced by exertion . Am Heart J 1932;;8:155-169.
23 +
Adams CW:  Functional paroxysmal ventricular tachycardia . Am J Cardiol 1962;;9:215-222.
24 +
Rally RC, Walter MB:  Paroxysmal ventricular tachycardia without evident heart disease . Can Med Assoc J 1962;;86:268-273.
25 +
Chapman JH, Schrank JP, Crampton RS:  Idiopathic ventricular tachycardia: An intracardiac electrical, hemodynamic and angiographic assessment of six patients . Am J Med 1975;;59:470-480.
26 +
VonBernuth G, Bernasau U, Gutheil H, et al:  Tachyarrhythmic syncope in children with structurally normal hearts with and without QT-prolongation in the electrocardiogram . Eur J Pediatr 1982;;138:206-210.
27 +
 Sudden, unexpected nocturnal deaths among Southeast Asian refugees . MMWR 1981;;30:581-584.
28 +
Baron RC, Thacker SB, Gorelkin L, et al:  Sudden death among Southeast Asian refugees: An unexplained nocturnal phenomenon . JAMA 1983;; 250:2947-2951.
29 +
Otto CM, Tauxe RV, Cobb LA, et al:  Ventricular fibrillation causes sudden death in Southeast Asian immigrants . Ann Intern Med 1984;;100:45-47.
30 +
Jacobson ML, Crowson TW:  Screening for depression in Hmong refugees . Minn Med 1983;;66: 573-574.
31 +
Baron RC, Kirschner RH:  Sudden night-time death among Southeast Asians too . Lancet 1983;;1: 764.
32 +
Talbott E, Kuller LH, Detre K, et al:  Biologic and psychosocial risk factors of sudden death from coronary disease in white women . Am J Cardiol 1977;;39:858-864.

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1 +
Cannon SB:  Voodoo death . Am Anthropol 1942;;44:169-181.
2 +
Engle GL:  Sudden and rapid death during psychological stress . Ann Intern Med 1971;;74:771-782.
3 +
Rahe RH, Romo M, Bennett L, et al:  Recent life changes, myocardial infarction, and abrupt coronary death . Arch Intern Med 1974;;133:221-228.
4 +
Myers A, Dewar HA:  Circumstances attending 100 sudden deaths from coronary artery disease with coroner's necropsies . Br Heart J 1975;;37:1133-1143.
5 +
Lown B, Temte JV, Reich P, et al:  Basis for recurring ventricular fibrillation in the absence of coronary heart disease and its management . N Engl J Med 1976;;294:623-629.
6 +
Trichopolus D, Katsouyanni K, Zavitsanos X, et al:  Psychological stress and fatal heart attack: The Athens (1981) earthquake natural experiment . Lancet 1983;;1:441-444.
7 +
Harvey WP, Levine SA:  Paroxysmal ventricular tachycardias due to emotion: Possible mechanism of death from fright . JAMA 1951;;150:479-480.
8 +
Reich P, DeSilva RA, Lown B, et al:  Acute psychological disturbances preceding life-threatening ventricular arrhythmias . JAMA 1981;;246:223-235.
9 +
Lown B, Verrier RL, Rabinowitz SH:  Neural and psychologic mechanisms and the problem of sudden cardiac death . Am J Cardiol 1977;;39:890-902.
10 +
Skinner JE, Lie JT, Entman ML:  Modification of ventricular fibrillation latency following coronary artery occlusion in the conscious pig: The effects of psychological stress and β-adrenergic blockade . Circulation 1975;;51:657-667.
11 +
Levine SA, Woodworth CR:  Congenital deaf-mutism, prolonged QT interval, syncopal attacks and sudden death . N Engl J Med 1959;;259:412-417.
12 +
Wellens HJJ, Vermeulen A, Durrer D:  Ventricular fibrillation occurring on arousal from sleep by auditory stimuli . Circulation 1972;;46:661-665.
13 +
Frank JP, Friedenberg DZ:  Syncope with prolonged QT interval . AJDC 1976;;130:320-322.
14 +
Gettes LS, Surawicz B:  Long-term prevention of paroxysmal arrhythmias with propranolol therapy . Am J Med Sci 1967;;254:257-265.
15 +
Coumel P, Fidelle J, Lucet V, et al:  Catecholamine-induced severe ventricular arrhythmias with Adams-Stokes syndrome in children: Report of four cases . Br Heart J 1978;;40:28-37.
16 +
Woosley RL, Kornhauser D, Smith R, et al:  Suppression of chronic ventricular arrhythmias with propranolol . Circulation 1979;;60:820-826.
17 +
Wu D, Kou HC, Hung JS:  Exercise-triggered paroxysmal ventricular tachycardia: A repetitive rhythmic activity possibly related to afterdepolarization . Ann Intern Med 1981;;95:410-414.
18 +
Brodsky MA, Sato DA, Allen BJ, et al:  Solitary β-blocker therapy for idiopathic life-threatening ventricular tachyarrhythmias . Chest 1986;;89:790-794.
19 +
Lown B, Tykocinski M, Garfein A, et al:  Sleep and ventricular premature beats . Circulation 1973;;48:691-701.
20 +
Taggart P, Carruthers M, Somerville W:  Electrocardiogram, plasma catecholamines and lipids and their modification by oxprenolol when speaking before an audience . Lancet 1973;;2:341-345.
21 +
Bernadt MW, Silverstone T, Singleton W:  Behavioral and subjective effects of β-adrenergic blockade in phobic subjects . Br J Psychiatry 1980;; 137:452-457.
22 +
Wilson FN, Wishart SW, Macleod AG, et al:  A clinical type of paroxysmal tachycardia of ventricular origin in which paroxysms are induced by exertion . Am Heart J 1932;;8:155-169.
23 +
Adams CW:  Functional paroxysmal ventricular tachycardia . Am J Cardiol 1962;;9:215-222.
24 +
Rally RC, Walter MB:  Paroxysmal ventricular tachycardia without evident heart disease . Can Med Assoc J 1962;;86:268-273.
25 +
Chapman JH, Schrank JP, Crampton RS:  Idiopathic ventricular tachycardia: An intracardiac electrical, hemodynamic and angiographic assessment of six patients . Am J Med 1975;;59:470-480.
26 +
VonBernuth G, Bernasau U, Gutheil H, et al:  Tachyarrhythmic syncope in children with structurally normal hearts with and without QT-prolongation in the electrocardiogram . Eur J Pediatr 1982;;138:206-210.
27 +
 Sudden, unexpected nocturnal deaths among Southeast Asian refugees . MMWR 1981;;30:581-584.
28 +
Baron RC, Thacker SB, Gorelkin L, et al:  Sudden death among Southeast Asian refugees: An unexplained nocturnal phenomenon . JAMA 1983;; 250:2947-2951.
29 +
Otto CM, Tauxe RV, Cobb LA, et al:  Ventricular fibrillation causes sudden death in Southeast Asian immigrants . Ann Intern Med 1984;;100:45-47.
30 +
Jacobson ML, Crowson TW:  Screening for depression in Hmong refugees . Minn Med 1983;;66: 573-574.
31 +
Baron RC, Kirschner RH:  Sudden night-time death among Southeast Asians too . Lancet 1983;;1: 764.
32 +
Talbott E, Kuller LH, Detre K, et al:  Biologic and psychosocial risk factors of sudden death from coronary disease in white women . Am J Cardiol 1977;;39:858-864.

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