Brunckhorst C B, Holzmeister J, Scharf C, Binggeli C, Duru F
Kardiologische Abteilung, Universitäts-Spital Zürich.
Ther Umsch. 2003 Nov;60(11):673-81. doi: 10.1024/0040-5930.60.11.673.
A relationship between behavioural factors and cardiac arrhythmogenesis in humans has been described. Three sets of conditions contribute to the occurrence of arrhythmias: myocardial electrical instability, most often due to coronary artery disease; an acute triggering event, frequently related to mental stress; and a chronic, pervasive, and intense psychological state, often including depression and hopelessness. The autonomic nervous system plays an important role in the occurrence of cardiac arrhythmias and it is well documented that mood alterations as mental stress and depression influence cardiac autonomic balance. There is an increasing body of evidence that patients with the greatest changes in cardiac neural regulation with decreased parasympathetic tone coupled with increased sympathetic activity are at the greatest risk for developing fatal ventricular arrhythmias. These patients have a reduced heart rate variability, increased QT-dispersion and a decreased baroreceptor sensitivity. The influence of stress and depression on the autonomic nervous system and the impact on the occurrence of both atrial and ventricular arrhythmias is being discussed.
行为因素与人类心律失常发生之间的关系已被描述。三组情况促成心律失常的发生：心肌电不稳定，最常见于冠状动脉疾病；急性触发事件，常与精神压力有关；以及慢性、普遍且强烈的心理状态，通常包括抑郁和绝望。自主神经系统在心律失常的发生中起重要作用，并且有充分的文献记载，诸如精神压力和抑郁等情绪变化会影响心脏自主神经平衡。越来越多的证据表明，心脏神经调节变化最大、副交感神经张力降低且交感神经活动增加的患者发生致命性室性心律失常的风险最高。这些患者心率变异性降低、QT离散度增加且压力感受器敏感性降低。本文正在讨论压力和抑郁对自主神经系统的影响以及对房性和室性心律失常发生的影响。
