Can Anger or Physical Exertion Trigger Acute Myocardial Infarction?

Anger or emotional upset and engaging in intense physical exertion could be triggers for acute myocardial infarction (AMI), according to the results of an international, case-crossover study.

Physical exertion, anger, and emotional upset have been reported to trigger AMI. Therefore, in order to quantify the importance of these potential triggers, researchers conducted a case-control study of first AMI in 12,461 individuals, estimating odds ratios for AMI occurring within 1 hour of triggers.
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Overall, 13.6% (n=1650) engaged in physical activity and 14.4% (n=1752) were angry or emotionally upset an hour before symptom onset. Physical activity during the case period was associated with increased odds of AMI (odds ratio 2.31) with a population-attributable risk of 7.7%. Anger and emotional upset during the case period was associated with an odds ratio of 2.44, with a population-attributable risk of 8.5%. No effect modification was observed with prior cardiovascular disease, cardiovascular risk factor burden, cardiovascular prevention medications, or time of AMI onset.

“We report that physical exertion and anger or emotional upset are common in the 1 hour before the onset of symptoms of AMI and that either exposure may act as an external trigger for AMI,” the researchers concluded.

—Michael Potts

Reference:
Smyth A, O’Donnell M, Lamelas P, Teo K, Rangarajan S, Yusuf S; INTERHEART Investigators. Physical activity and anger or emotional upset as triggers of acute myocardial infarction: the INTERHEART study [published online October 11, 2016]. doi:http://dx.doi.org/10.1161/CIRCULATIONAHA.116.023142.