Exhausted subjects, exhausted systems.

A state of 'vital exhaustion', characterized by unusual tiredness, increased irritability and feelings of demoralization has been found to preceed the onset of myocardial infarction and to increase the risk of a new coronary event after angioplasty. Probably this state reflects a decreased activity of the hypothalamic-pituitary-adrenal axis as part of an homeostatic reaction to prolonged stress and inflammation.