Ziegelstein Roy C
Department of Medicine, Johns Hopkins University School of Medicine and Division of Cardiology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland 21224-2780, USA.
JAMA. 2007 Jul 18;298(3):324-9. doi: 10.1001/jama.298.3.324.
Episodes of acute emotional stress can have significant adverse effects on the heart. Acute emotional stress can produce left ventricular contractile dysfunction, myocardial ischemia, or disturbances of cardiac rhythm. Although these abnormalities are often only transient, their consequences can be gravely damaging and sometimes fatal. Despite the many descriptions of catastrophic cardiovascular events in the setting of acute emotional stress, the anatomical substrate and physiological pathways by which emotional stress triggers cardiovascular events are only now being characterized, aided by the advent of functional neuroimaging. Recent evidence indicates that asymmetric brain activity is particularly important in making the heart more susceptible to ventricular arrhythmias. Lateralization of cerebral activity during emotional stress may stimulate the heart asymmetrically and produce areas of inhomogeneous repolarization that create electrical instability and facilitate the development of cardiac arrhythmias. Patients with ischemic heart disease who survive an episode of sudden cardiac death in the setting of acute emotional stress should receive a beta-blocker. Nonpharmacological approaches to manage emotional stress in patients with and without coronary artery disease, including social support, relaxation therapy, yoga, meditation, controlled slow breathing, and biofeedback, are also appropriate to consider and merit additional investigation in randomized trials.
急性情绪应激发作可对心脏产生重大不利影响。急性情绪应激可导致左心室收缩功能障碍、心肌缺血或心律失常。尽管这些异常通常只是短暂的，但其后果可能具有严重破坏性，有时甚至是致命的。尽管在急性情绪应激情况下对灾难性心血管事件已有诸多描述，但借助功能神经影像学的出现，情绪应激触发心血管事件的解剖学基础和生理途径才刚刚得到明确。最近的证据表明，大脑活动不对称在使心脏更容易发生室性心律失常方面尤为重要。情绪应激期间大脑活动的偏侧化可能会不对称地刺激心脏，并产生复极不均匀区域，从而造成电不稳定并促进心律失常的发生。在急性情绪应激情况下经历过心脏性猝死发作但存活下来的缺血性心脏病患者应接受β受体阻滞剂治疗。对于有或没有冠状动脉疾病的患者，管理情绪应激的非药物方法，包括社会支持、放松疗法、瑜伽、冥想、控制缓慢呼吸和生物反馈，也适合考虑，并值得在随机试验中进行更多研究。
