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Emotional disturbance as a cause of an acute cardiac insult
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      Abstract

      An acute cardiac insult may be induced by a severe emotional upset. In most instances it occurs in persons who have underlying latent coronary atheromatosis. The acute cardiac insult in such cases consists of acute structural alterations in the atheromatous processes induced by intimai capillary hemorrhage resulting in acute reactive changes, with gradual onset of thrombosis which may end in complete occlusion and myocardial infarction after several days. In some cases sudden rupture of an atheromatous plaque may take place resulting in acute coronary thrombosis. In many cases the process may be arrested before infarction sets in. These show early the ischemic myocardial phase which abates after some time, or focal necrosis may develop.
      The mechanism of the production of these pathologic processes under acute emotional strain appears to be a sudden rise in arterial blood pressure which is transmitted to the intimal capillaries causing their rupture. Additional factors are accelerated coagulability of blood and hemoconcentration occurring under emotional strain, as well as coronary angiospasm.
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