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Extreme exertion, emotion can spark repeat heart attacks

potent when acting in combination or when they are present at particular times of day."

Nevertheless, Strike and Steptoe also cautioned that results are often collected by asking patients or survivors to compare normal activity with what they did immediately before the heart attack.

Such reports are "susceptible to memory loss, social acceptability bias and to patients' private beliefs about the causes of heart disease," the authors say. Also, some apparent triggers may actually be symptoms, rather than causes, of the earliest stages of a heart attack.

Steptoe believes the review has important implications for clinicians. "Physicians and cardiologists need to talk to patients with ACS (acute coronary syndromes) about their experiences in the hours leading up to the cardiac event," he says. For example, if a heart attack occurs after vigorous exertion, the patient may be fearful of future exercise. "Patients need to realize that they would still benefit greatly from regular physical activity."

Evidence linking various psychosocial factors with coronary artery disease has grown so strong that the Journal of the American College of Cardiology recently featured an article on the emerging field of "behavioral cardiology."

Lead author Dr. Alan Rozanski, of St Luke's-Roosevelt Hospital Center and Columbia University in New York, says "The real battlefield has become 'What should cardiologists do with this information?' given that there are no guidelines for integrating the management of psychological factors into cardiac practice."

He and coauthors recommend that, for now, cardiac specialists screen for psychosocial issues, recognize that some of these issues can be managed within cardiac practice and consider referring patients with severe psychological issues to appropriate specialists.


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Contact: Andrew Steptoe
a.steptoe@ucl.ac.uk
Center for the Advancement of Health
22-Mar-2005


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