Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces...
Transcript of Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces...
![Page 1: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/1.jpg)
Neural and Emotional triggers in Acute coronary syndrome
www.drsvenkatesan.com
![Page 2: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/2.jpg)
Dr.S.VenkatesanMadras medical college , Chennai
Neural and Emotional triggers in Acute coronary syndrome
www.drsvenkatesan.com
![Page 3: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/3.jpg)
• ACS- A brief • Vulnerable plaque • Risk factor vs triggers• Epidemiological data• Clinical evidence • Impact of various emotions • Physiological basis of neural link • Pacifying triggers• Prevention
Scheme
www.drsvenkatesan.com
![Page 4: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/4.jpg)
•Acute MI /STEMI
•Unstable angina/NSTEMI
•Sudden cardiac death
Acute coronary syndrome
www.drsvenkatesan.com
![Page 5: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/5.jpg)
www.drsvenkatesan.com
![Page 6: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/6.jpg)
www.drsvenkatesan.com
![Page 7: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/7.jpg)
www.drsvenkatesan.com
![Page 8: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/8.jpg)
Acute coronary occlusion
www.drsvenkatesan.com
![Page 9: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/9.jpg)
www.drsvenkatesan.com
![Page 10: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/10.jpg)
Primary PCI : The new age modality
www.drsvenkatesan.com
![Page 11: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/11.jpg)
www.drsvenkatesan.com
![Page 12: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/12.jpg)
www.drsvenkatesan.com
![Page 13: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/13.jpg)
ACS–Outcome
• Greatly improved• Still Prohibitive• 20% out of hospital • 7 % in CCU •10 % 1 yearwww.drsvenkatesan.com
![Page 14: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/14.jpg)
What is the culprit ?
www.drsvenkatesan.com
![Page 15: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/15.jpg)
www.drsvenkatesan.com
![Page 16: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/16.jpg)
Lipid core / Fibrous Cap/ plaque stress/ fatigue
Eccentric soft gruel
Critical points at cap shoulders
www.drsvenkatesan.com
![Page 17: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/17.jpg)
www.drsvenkatesan.com
![Page 18: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/18.jpg)
MMP central role plaque vulnerability ?
20 MMPs identified
collectively called matrixins, are proteinases
MMP 8 culprit
Degrades fibrillor collagen
Tissue inhibitors of metalloproteinases (TIMPs) are specific inhibitors
TIMP
www.drsvenkatesan.com
![Page 19: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/19.jpg)
Trapping the killer MMP with TIMP 2
www.drsvenkatesan.com
![Page 20: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/20.jpg)
Risk factors vs Triggers
www.drsvenkatesan.com
![Page 21: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/21.jpg)
www.drsvenkatesan.com
![Page 22: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/22.jpg)
Trigger: An activity that produces short-term physiological
changes that may lead directly to onset of acute CVD.
Acute risk factor: A short-term physiological
change,such as a surge in arterial pressure or heart rate, an increase in coagulability, or vasoconstriction, that follows a triggerand may result in disease onset.
Hazard period: The time interval after trigger
initiation associated with an increased risk of disease onset because of the trigger. The onset and offset times of the hazardperiod, which could also be designated a “vulnerable
www.drsvenkatesan.com
![Page 23: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/23.jpg)
“For every ACS to manifest a trigger . . . seems to be essential over and above the baseline chronic risk profile”
www.drsvenkatesan.com
![Page 24: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/24.jpg)
www.drsvenkatesan.com
![Page 25: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/25.jpg)
PhysicalEmotional Neural Systemic illness
Types of triggers
www.drsvenkatesan.com
![Page 26: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/26.jpg)
Physical triggers –early evidence
Clustering of events Diurnal variationPhysical exertion
www.drsvenkatesan.com
![Page 27: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/27.jpg)
www.drsvenkatesan.com
![Page 28: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/28.jpg)
www.drsvenkatesan.com
![Page 29: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/29.jpg)
www.drsvenkatesan.com
![Page 30: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/30.jpg)
Where is the evidence coming from?
• Fear• Anger• Anxiety• Depression
Negative emotions
www.drsvenkatesan.com
![Page 31: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/31.jpg)
www.drsvenkatesan.com
![Page 32: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/32.jpg)
www.drsvenkatesan.com
![Page 33: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/33.jpg)
www.drsvenkatesan.com
![Page 34: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/34.jpg)
www.drsvenkatesan.com
![Page 35: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/35.jpg)
National sports loss as a trigger
www.drsvenkatesan.com
![Page 36: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/36.jpg)
www.drsvenkatesan.com
![Page 37: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/37.jpg)
Plaque
Destability
Hematological
Inflammation
Hemodynamic
Psychosocial
Cytokines
www.drsvenkatesan.com
![Page 38: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/38.jpg)
Scientific evidence
www.drsvenkatesan.com
![Page 39: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/39.jpg)
ONSET (Mittleman NEJM1993)
SHEEP (J Epidemiol Commun Health. 2005)
TRIMM (Willich NEJM 1993)
www.drsvenkatesan.com
![Page 40: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/40.jpg)
www.drsvenkatesan.com
![Page 41: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/41.jpg)
Physical exertion as trigger
www.drsvenkatesan.com
![Page 42: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/42.jpg)
Muller JE,. JAMA. 1996;275:1405–1409.Moller J, (SHEEP). Heart. 2001;86:387–390.
Sexual activity as trigger
ONSET/SHEEP data specific analysis (>2.5-3 fold) There is a casual associationLow absolute risk Different from Gen population /Post MI
www.drsvenkatesan.com
![Page 43: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/43.jpg)
Anger as Trigger
www.drsvenkatesan.com
![Page 44: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/44.jpg)
www.drsvenkatesan.com
![Page 45: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/45.jpg)
Timing of anger and the event
www.drsvenkatesan.com
![Page 46: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/46.jpg)
53 % had life stress events
Our experience
www.drsvenkatesan.com
![Page 47: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/47.jpg)
Emotional triggers : Summary
Overwhelming epidemiological data Individual cases reportsCommunity statistics Anger and acute life stress dominated
www.drsvenkatesan.com
![Page 48: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/48.jpg)
Depression
Anxiety
Anger Fear
Trigger RiskFactor
ACS CAD
Dual risk for emotions : Acts both as trigger / Risk factor
www.drsvenkatesan.com
![Page 49: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/49.jpg)
Physiological basis of the Neuro –emotional cardiac link
www.drsvenkatesan.com
![Page 50: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/50.jpg)
Central sympathetic network
Cingulate gyrusFrontal Temporal Parietal
www.drsvenkatesan.com
![Page 51: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/51.jpg)
www.drsvenkatesan.com
![Page 52: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/52.jpg)
www.drsvenkatesan.com
![Page 53: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/53.jpg)
Neurobiology of stress
Neuro- endocrine activation Immuno inflammatory vascular pathway
5 fold increase in cardiac events
Ref 1.Frassure Smith (Circulation 1995)2.Van malle 2004 psychosomatic medicine Meta analysis
www.drsvenkatesan.com
![Page 54: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/54.jpg)
www.drsvenkatesan.com
![Page 55: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/55.jpg)
Catecholamine toxicity
www.drsvenkatesan.com
![Page 56: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/56.jpg)
www.drsvenkatesan.com
![Page 57: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/57.jpg)
Looking beyond catecholamine
www.drsvenkatesan.com
![Page 58: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/58.jpg)
Orexnergic system (hypocretin receptor)
• Cortical -Hypothalamic arousal system • Stimulation causes the elevation of BP • High levels are associated with hyper arousal /Stress
www.drsvenkatesan.com
![Page 59: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/59.jpg)
Hyper-arousal is a trigger
www.drsvenkatesan.com
![Page 60: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/60.jpg)
www.drsvenkatesan.com
![Page 61: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/61.jpg)
Stress and hematological effects
Pro-coagulant hemostatic responsesIncreased blood viscosityFibrinogen concentration Increased platelet adhesion
www.drsvenkatesan.com
![Page 62: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/62.jpg)
Stress and hematological effects
www.drsvenkatesan.com
![Page 63: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/63.jpg)
Serotonin : Brain–Platelet interaction
5HT receptor density increased 5HT transporter reduced both in brain and plateletIntracellular calcium increasePlatelet factor 4 and B Thromboglobulin
www.drsvenkatesan.com
![Page 64: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/64.jpg)
Neuro electrical trigger
www.drsvenkatesan.com
![Page 65: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/65.jpg)
Clinical evidence for Neuro cardiac link
Stroke Epilepsy Stress cardiomyopathy
www.drsvenkatesan.com
![Page 66: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/66.jpg)
ECG in stroke
www.drsvenkatesan.com
![Page 67: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/67.jpg)
Holter recording during seizures
www.drsvenkatesan.com
![Page 68: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/68.jpg)
Sudden cardiac deaths during seizures The mystery Ictal asystole and VF
Seizure induced ventricular fibrillation: A case of near-SUDEP Monica Ferlisia, , RuggeroTomeib,Monica Carlettib, Seizure Volume 22, Issue 3, April 2013, Pages 249–251
www.drsvenkatesan.com
![Page 69: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/69.jpg)
Para ventricular nucleusTriggers VF in animals
Is the heart a neurological end organ ?
Mechanism of primary VF
www.drsvenkatesan.com
![Page 70: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/70.jpg)
Para sympathetic vs sympathetic . Right vs left www.drsvenkatesan.com
![Page 71: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/71.jpg)
Neural sprouting
www.drsvenkatesan.com
![Page 72: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/72.jpg)
Neural sprouting – S 100
positive fibrotic myocardium
www.drsvenkatesan.com
![Page 73: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/73.jpg)
Cervical sympathectomyBeta blockersPost transplant hearts
Evidence for benefits with Neuronal blockade
www.drsvenkatesan.com
![Page 74: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/74.jpg)
Beta blockers
Key role Entire spectrum of CAD
CSA UA MI SC
Backed by mega trials , without dispute www.drsvenkatesan.com
![Page 75: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/75.jpg)
Learning from de-nerved heart
www.drsvenkatesan.com
![Page 76: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/76.jpg)
The concept of emotional stress testing
www.drsvenkatesan.com
![Page 77: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/77.jpg)
Can we screen for the trigger prone ?
www.drsvenkatesan.com
![Page 78: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/78.jpg)
Lessons from a lost President
A charming dreamer , deep love for the nation . . .gave his life Unknown Trigger ?www.drsvenkatesan.com
![Page 79: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/79.jpg)
Emotional stress testingST depression Wall motion defect
Newer protocols are defined
www.drsvenkatesan.com
![Page 80: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/80.jpg)
PET imaging of emotions
www.drsvenkatesan.com
![Page 81: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/81.jpg)
www.drsvenkatesan.com
![Page 82: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/82.jpg)
www.drsvenkatesan.com
![Page 83: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/83.jpg)
Catecholamine Imaging
Reduced myocardial stores, Rapid washout , and spill over in CHF www.drsvenkatesan.com
![Page 84: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/84.jpg)
Markovitx Mathews psychosomatic medicine ,1991Musselman , Manatunga Am J of psychiatry ,1997
Treating Depression and prevention of cardiac events
•SAD - HEART •CREATE •MIND IT
www.drsvenkatesan.com
![Page 85: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/85.jpg)
Positive emotions:Protection
PrayerSocial support YogaMeditationMusic
www.drsvenkatesan.com
![Page 86: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/86.jpg)
Passivating triggers Avoiding extreme exertionImproving emotional intelligence Anger management Drugs –Antidepressant Public health measure (Air pollution / disaster response /Aiming for social peace )
www.drsvenkatesan.com
![Page 87: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/87.jpg)
Concluding messages
• Strong neuro cardiac link in ACS exist.• Triggers are vital • Baseline risk factor is the key• Triggers per-se for fatality seems rare. • Standard medical treatment is crucial
www.drsvenkatesan.com
![Page 88: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/88.jpg)
Can we eliminate these triggersCompletely ?
Emotions Integral part of life
Only a fraction transform to clinical events
What is the missing link ?www.drsvenkatesan.com
![Page 89: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/89.jpg)
www.drsvenkatesan.com
![Page 90: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/90.jpg)
Knowledge will evolve . . .
• Time ?• Metaphysics ?• Heisenberg ?
www.drsvenkatesan.com
![Page 91: Neural and Emotional triggers in Acute coronary syndrome...Trigger: An activity that produces short-term physiological changes that may lead directly to onset of acute CVD. Acute risk](https://reader034.fdocuments.in/reader034/viewer/2022051823/5fed982a5de4d0190941df5b/html5/thumbnails/91.jpg)
! “Meanwhile . . . It’s highly likely a cool mind can definitely prevail over the heart”
Thank you www.drsvenkatesan.com