Sudden Cardiac Death

There is compelling evidence that psychosocial factors can cause sudden cardiac death. Overwhelming emotion can cause arrhythmia and spasm of the coronary arteries; individually or together these could lead to fatal interruption of blood flow the heart muscles.

Like heart attacks, sudden arrhythmias are most likely to occur in the morning with the peak frequency between 8 and 11 am (more specifically, the first two hours after arising). The incidence of cardiac arrests peaks on Mondays and has the greatest incidence in winter.

Intense stressors, such as earthquakes, are associated with increased cardiac mortality. Collected data from implantable defibrillators showed an increase in arrhythmias both in the New York City area and around the world on 9/11. A diagnosis of cancer may increase the risk of cardiovascular death. A cohort study using multiple registries examined the risk in more than 6,000,000 Swedes from 1991 through 2006; compared with cancer-free individuals, patients diagnosed with cancer were six times more likely to die from cardiovascular causes within one week of receiving the diagnosis.

Depression and hostility are behaviors that are associated with an increased risk of coronary heart disease related events. Increased mortality following a heart attack is seen with social isolation and lack of emotional support.

In summary, considerable data supports a role for psychosocial factors in sudden death — both acutely with anger and chronically with states of depression, hostility, and social isolation. Stress management, combined with beta-blockers and aspirin may be helpful interventions.