Triggering Of Acute Coronary Syndromes By Physical Exertion And Anger

Abstract

Objectives: To assess the role of vigorous physical exertion and anger as triggers of acute coronary syndromes (ACS). Materials And Methods: This prospective observational study was conducted at the Punjab Institute of Cardiology, Lahore from April to September 2010. Two hundred patients admitted through emergency and out patient department were studied. Patients were questioned in detail about the circumstances surrounding the onset of acute symptoms. Anger was assessed according to the anger scale comprising of 7 points and physical activity was assessed according to activity scale also comprising of 7 points.  Results: The mean age of the study population was 54.2±10.8 years. There were 149(74.5%) males and 51(25.5%) females. Diabetes mellitus occurred in 69(34.5%), hypertension 86(43%), smoking 71(35.5%) and dyslipidemia in 51(25.5%) patients. Majority of patients had low education status with primary education in 75(37.5%) and illiteracy in 74(37%) patients. Premonitory symptoms occurred in 92(46%) patients. Most patients 65(32.5%) presented to the hospital in 6-12 hours duration of onset of symptoms followed by 54(27%) patients presenting in 0-6 hours. Typical chest pain occurred in 166(83%) patients. Mostly patients 123(61.5%) had ST segment elevation myocardial infarction, followed by Non ST segment elevation myocardial infarction in 45(22.5%) and unstable angina in 31(15.5%) patients. The onset anger scale identified 25(12.5%) patients having associated anger at the time of onset of symptoms. According to anger scale,  level 1 anger was observed in 5(2.5%), level 3 in 3(1.5%), level 4 in 4(2%), level 5 in 5(2.5%), level 6 in 6(3%) and level 7 in 2(1%) patients. The history of exertion at the time of onset of symptoms revealed that 95(47.5%) patients had level 1 exertion followed by level 2 exertion in 61(30.5%) and level 4 exertion in 14(7%) patients. Conclusion: This study confirms previous results and shows a graded exposure–response relationship between physical exertion intensity and triggering of AMI onset. The specific clinical and sociodemographic factors associated with physical exertion and anger suggest that different pathophysiological processes may be involved.