HONOLULU, April 24 – Psychosocial stress is a more common trigger for sudden cardiac arrest than physical exertion for women, while the opposite is true for men, according to a study presented today at the American Heart Association’s Asia Pacific Scientific Forum.
“The factors that cause sudden cardiac arrest are hard to pin down, but our study shows that men and women may have different triggers,” says Norman Ratliff, M.D., cardiology fellow at the University of Minnesota/Minneapolis Heart Institute Foundation in Minneapolis.
Cardiac arrest occurs when the heart’s electrical impulses become rapid or chaotic, causing the heart to stop beating. Death is imminent unless a person is treated within minutes with an electrical shock from a device called a defibrillator.
Researchers studied 122 men and women who had suffered an out-of-hospital cardiac arrest and had been given an implantable defibrillator to correct future episodes of chaotic heartbeats.
The participants filled out a questionnaire that included detailed information about activities prior to their sudden cardiac arrests. They were also asked about psychological factors defined as psychosocial stressors, or emotional triggers, such as whether they had experienced a divorce, death of a loved one, family conflicts or other significant life events.
Women were more likely to report that they had experienced one or more psychological stressors, rather than physical exertion prior to cardiac arrest. Of the 20 women in the study, 40 percent said they experienced psychological stressors and only 5 percent reported physical exertion. Forty percent of the men reported physical stress and 16 percent reported emotional stress before their cardiac arrest.
Many of the people in the study – 45 percent of the women and 38 percent of the men – had not been on any medication prior to the cardiac arrest. Only 50 percent of the women and 33 percent of men had no prior history of cardiac disease, and 90 percent of the patients were asymptomatic prior to the event.
“Sudden cardiac arrest is a huge public health burden and we still don’t completely understand all inciting events. This study suggests that emotional triggers may be important in some cases,” Ratliff adds.
“Many women may present with subtle symptoms, such as palpitations. We as physicians need to pay closer attention to the emotional status of patients with heart disease because stressful life events have the potential to trigger adverse events,” he says.
The study may mean that the mechanism of sudden death begins on a different biological pathway for men than for women. Physical exertion may cause an increased level adrenaline for men, while emotional stress may cause the same rise in women, says Ratliff. Adrenaline is a stress hormone that can cause rapid heart beats. An estimated 250,000 people die each year of coronary heart disease without being hospitalized. Most of these are sudden deaths caused by cardiac arrest.
Co-authors are Robert Hauser; M.D.; Adrian Almquist, M.D.; Julka Almquist, Fredarick Gobel, M.D.; and Mike Ornes, M.D.
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