Department of Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Montescano, Pavia, Italy.
Department of Oncology and Hemato-Oncology, University of Milan, Italy.
Auton Neurosci. 2022 Jan;237:102921. doi: 10.1016/j.autneu.2021.102921. Epub 2021 Nov 18.
The existence of an important relationship between stress, the autonomic nervous system, and sudden cardiac death (SCD) has been long recognized. In the present essay we review the large number of conditions, acting at individual or at population level, that have been causally associated to SCD and discuss the mechanistic and translational value of the studies exploring such associations. These conditions include external stressors (earthquakes, wars) and internal stressors (anger, fear, loss of a loved one) and emotions of even opposite sign. Most situations confirm the time-honored view that increases in sympathetic activity are proarrhythmic whereas increases in vagal activity are protective; however, we will also show and discuss a condition in which the culprit appears to be the excess of vagal activity. The physiologic rationale underlying the most typical situations is on one hand the profibrillatory effect of the increase in the heterogeneity of repolarization secondary to the release of norepinephrine, and on the other the combined effect of acetylcholine to lower heart rate and to antagonize the cardiac effects of norepinephrine at ventricular level. An interesting facet of this potentially lethal relationship is that the elements involved are by no means always exceptional, and they can actually represent part of our everyday life.
长期以来，人们一直认识到压力、自主神经系统与心源性猝死（SCD）之间存在着重要关系。在本文中，我们回顾了大量已被证实与 SCD 相关的个体和群体水平的条件，并讨论了探索这些关联的研究的机制和转化价值。这些条件包括外部压力源（地震、战争）和内部压力源（愤怒、恐惧、失去亲人）以及相反的情绪。大多数情况下都证实了一个由来已久的观点，即交感神经活动的增加会导致心律失常，而迷走神经活动的增加则具有保护作用；然而，我们也将展示和讨论一种似乎是迷走神经活动过度导致的情况。最典型情况下的生理基本原理一方面是去甲肾上腺素释放引起复极异质性增加导致的纤维颤动效应，另一方面是乙酰胆碱降低心率并在心室水平拮抗去甲肾上腺素对心脏的作用。这种潜在致命关系的一个有趣方面是，涉及的因素并非总是例外，它们实际上可能是我们日常生活的一部分。
