Mental stress, panic disorder and the heart

The central theme presented is that chronic stress responses contribute to the development of coronary artery disease, and that acute stress responses can act as a trigger for the clinical presentation of underlying, previously silent heart disease. There is evidence of a contribution of stress to the development of coronary atherosclerosis and to the triggering of clinical complications, such as fatal arrhythmias and myocardial infarction in the presence of underlying coronary artery disease. The principal mediating mechanism is activation of the sympathetic nervous system. Panic attacks are uncommonly complicated by cardiac events such as coronary spasm and myocardial infarction, and represent an explicit demonstration of the stress-heart link. (C) 1998 John Wiley & Sons, Ltd.