Engel G L
Ann Intern Med. 1978 Sep;89(3):403-12. doi: 10.7326/0003-4819-89-3-403.
Giving up in the face of emotional arousal and psychologic uncertainty are conditions conducive both to vasodepressor syncope and sudden death. Under such circumstances there may be simultaneous activation of two emergency biologic regulatory systems, flight-fight and conservation-withdrawal. In the healthy person this may result in vasodepressor syncope, benign arrhythmias, or both. In the presence of factors lowering the threshold for conduction disturbances, dangerous arrhythmias and sudden death rather than, or as well as, vasodepressor syncope may result. Although active myocardial damage by itself may provide the necessary and sufficient conditions for lethal arrhythmias, psychic uncertainty must be considered an additional risk factor. The implications of this concept for patient care and prevention of sudden death are a challenge for future research.
在面对情绪激动和心理不确定性时放弃，这两种情况既容易引发血管减压性晕厥，也容易导致猝死。在这种情况下，可能会同时激活两种紧急生物调节系统，即战斗-逃跑系统和保存-退缩系统。对于健康人而言，这可能会导致血管减压性晕厥、良性心律失常，或两者皆有。如果存在降低传导障碍阈值的因素，则可能会导致危险的心律失常和猝死，而非血管减压性晕厥，或者两者同时发生。虽然活跃的心肌损伤本身可能为致命性心律失常提供必要且充分的条件，但心理不确定性也必须被视为一个额外的风险因素。这一概念对患者护理和猝死预防的影响，是未来研究面临的一项挑战。
