March 22, 2005 - The next time someone tells you to sit down before delivering emotional news or offers to shovel the driveway for you, you may want to follow their advice.
A new study shows "compelling" scientific evidence to back up the notion that extreme emotional and physical stress can trigger chest pain and heart attacks in vulnerable people, including couch potatoes and those with heart disease risk factors.
Researchers reviewed several studies on the subject and found consistent proof that physical exertion (particularly by people who are not normally active), emotional stress, anger, and extreme excitement can trigger chest pain, heart attack, and sudden cardiac death in those at risk.
Symptoms may begin as early as within one to two hours after exposure, and researchers say they're just beginning to understand the ways in which these triggers work.
Comparing Heart Attack Triggers
In the study, which appears in the current issue of Psychosomatic Medicine, researchers reviewed dozens of studies published between 1970 and 2004 on potential behavioral and emotional triggers of chest pain, heart attack, and sudden cardiac death.
Researchers defined a trigger as an external stimulus, emotional state, or activity that produces changes leading directly to heart attack, chest pain, or sudden cardiac death.
The results show that the strongest evidence supports a link between physical exertion, emotional stress, anger, and extreme excitement and heart risks. Several of the studies documented a spike in heart attacks following natural disasters, wars, and sporting events.
Other potential triggers of sudden chest pain relating to heart problems may include sexual activity, heavy drinking, sleep disturbances, or eating a high-fat meal, but researchers say strong evidence is lacking.
Risk Factors vs. Triggers
The review suggests that the behavioral and social risk factors that lead to heart disease over the long-term, such as such as cigarette smoking, lack of exercise, work stress, social isolation, anxiety and depression, are very different than those factors that act quickly to trigger events in vulnerable individuals.
For example, people who are physically active enjoy a lower risk of heart disease, but studies show that extreme physical activity among sedentary people can trigger sudden chest pain, a heart attack, or sudden cardiac death.
In one study, people who exercised rarely were nearly seven times more likely to suffer a heart attack after strenuous physical activity than those who exercised more than three times a week.
Researchers say it's likely that physical and emotional triggers are more potent when they are acting in combination, such as natural disasters that prompt emotional as well as physical stress.