Philip Strike and Andrew Steptoe of University College London, in a review published in the current issue of Psychosomatic Medicine, of dozens of studies done between 1970 and 2004 have come up with compelling evidence that indicates that people with a history of heart disease, can trigger heart attacks, some of them fatal, by physical exertion and emotional stress.
They found that “physical exertion has an apparently paradoxic association with triggering” severe chest pain, heart attack or sudden death.
Physically fit people enjoy a reduced risk of heart attacks, while inactive cardiac patients who suddenly engage in vigorous activity may do so at their peril.
They point out that the triggers for heart attacks may be quite different from the factors that lead to development of coronary heart disease over the long term, such as cigarette smoking, lack of exercise, work stress, social isolation, anxiety and depression.
One study found that people who exercised rarely were nearly seven times more likely to suffer a heart attack after strenuous exertion than those who exercised more than three times a week, but the risk of cardiac events after any single bout of activity remains less than one in a million, including sexual activity, where there is also a slightly elevated risk for heart patients.
Steptoe says strong social support and marital relationships promote physical well-being, and it is much more important for people to maintain good personal and sexual relationships than it is to worry about such a small increase in risk.
Emotional distress, along with natural disasters, war and sporting events may also trigger heart attacks in vulnerable individuals.
The evidence of triggering by physical exertion and emotional stress is compelling, and it is possible that triggers are more potent when acting in combination or when they are present at particular times of day.
The results are often collected by asking patients or survivors to compare normal activity with what they did immediately before the heart attack and these reports are susceptible to memory loss, social acceptability bias and to patients’ private beliefs about the causes of heart disease.