Effects of emotional excitement on heart rate and blood pressure dynamics in patients with coronary artery disease.

The incidence of adverse cardiovascular events is higher among spectators of exciting sports events, but the mechanistic link between the events is not known. We assessed the heart rate (HR) and blood pressure (BP) dynamics of enthusiastic male ice hockey spectators (60 ± 9 years) with coronary artery disease (CAD) during Finnish national league ice hockey play-off final matches. Twenty-four-hour ambulatory ECG (n = 55) and BP (n = 17) were recorded at the time of the match and on a control day. Beat-to-beat R-R intervals and BP were recorded during the match and a bicycle exercise at equal HR levels (n = 21). Systolic and diastolic BP were significantly higher 1h before, during, and 1h after the match than on the control day, e.g., the highest systolic BP was 180 ± 14 vs. 145 ± 15 and diastolic 103 ± 13 vs. 82 ± 11 mmHg (p<0.001 for both). HR was higher throughout the match (p<0.05) and remained elevated 2h after the match (p<0001), and measures of HR variability were decreased during the match (p<0.01). Low-frequency variability in BP was higher during the match than during the exercise test (p<0.01). The results show that cardiac vagal outflow is attenuated and vasomotor sympathetic activity elevated during exciting sports events and BP dynamics differ from those occurring during physical exercise at equal HRs. The autonomic reactions may partly explain the vulnerability to cardiovascular events caused by this type of leisure-time emotional excitement.