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Emotional and Physical Exertion and Risk for Sudden Death

by Hratch L Karamanoukian, MD and Pierre Aoukar, MD
Posted: February 25

Emotional and exercise related exertion is related to sudden cardiac death. Researchers at the Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC, USA, have investigated the reasons for this from autopsy heart specimens.

The goals of the authors were to determine the frequency of plaque rupture in sudden deaths related to exertion compared with sudden deaths not related to exertion. Exertion before death was determined by the investigator of the death and ruptured plaques were defined as intraplaque hemorrhage with disruption of the fibrous cap and luminal thrombus as defined by well established histopathologic criteria.

The frequency and morphology of plaque rupture was compared in men dying at rest versus those dying during exertion.

The mean number of vulnerable plaques in the coronary arteries of men in the exertional-death group was 1.6 and in the at-rest group was 0.9. The culprit plaque in men dying during exertion was plaque rupture in 68% versus 23% of men dying at rest. Hemorrhage into the plaque occurred in 72% of men in the exertional-death group and 41% of men in the rest group.

The authors of this study concluded that in men with severe coronary artery disease, sudden death related to exertion was associated with acute plaque rupture.

Methods to reduce stress levels and distress should be instituted in daily life. Methods to do so include meditation, relaxation and behavioral changes. Reduced "distress" can lower your cardiovascular risk, including sudden death from a heart attack, especially if you have coronary artery disease.

Plaque Rupture and Sudden Death Related to Exertion in Men with Coronary Artery Disease, JAMA 281:921-6

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