Acute myocardial infarction following an emotional disturbance

Workmen’s

Compensation

for the Cardiac Edited

by LOUIS H.

Brooklyn,

SIGLER,

M.D.,

F.A.C.C.

New York

Acute

Myocardial

Infarction

an Emotional

Disturbance pilot and co-pilot on this plane were killed. He suffered a severe emotional disturbance and one minute later he experienced severe pain in the center of his chest which lasted for a few minutes. The next morning, at or about 9:30 A.M., while on the flight line getting ready for his flight, the pain recurred and again lasted only a couple of minutes. He got into his plane and flew it to Honolulu. During the flight, he felt fine. After reaching Honolulu he had several hours of sleep; when he got up he again experienced discomfort in his chest. He consulted a doctor in Honolulu, who told him that he had “angina pectoris.” A short time after he left the doctor’s office he had another attack, which was more severe and intense. He returned to the doctor’s office where he was given an injection and transferred to a hospital; he was told that he had had a “heart attack” and was given oxygen. He was treated in the hospital for six weeks. Since his discharge from the hospital he has felt quite well, but has not returned to work. The family history was non-contributory. His past personal history revealed nothing abnormal. He had always enjoyed excellent health. During World War II he flew with the Flying Tigers Squadron. At no time before did he have any indigestion, shortness of breath or discomfort in his chest. There was no history of high blood pressure or nervous disorder. Examination about three months after the attack when I first saw him revealed a white man of small stature who was well nourished and looked his stated age; he appeared intelligent, cooperative and was in no apparent pain or discomfort. He weighed 149 pounds, and was 65 inches tall. The chest and lungs were normal. The heart showed no increase in dullness, and the sounds were regular in rhythm, of fair tone and quality. No murmurs were heard. The blood pressure was 1 lo/90 mm. Hg.

N a previous report’ I discussed the subject of emotional disturbance as a cause of an acute cardiac insult. I presented some of the possible physiologic and pathologic changes responsible for such an insult under emotional strain. The following case, which was sent to me for review by a physician from Los Angeles, further illustrates the causal relationship between a severe emotional upset and an acute myocardial infarction. The case is of interest because the condition occurred in an apparently perfectly healthy person, forty-two years of age, an airplane pilot who usually is not easily disturbed by danger or by an exciting event. It also illustrates the intermittency of subjective manifestations as the pathologic process progressed for about two days before the diagnosis was established. During this interval there were periods when he felt quite well, and even piloted his plane over a stretch from the West Coast to Hawaii without discomfort. It is hoped that more cases illustrating the effect of emotion and strain upon the heart will be brought to our attention.

I

CASE REPORT* A forty-two year old married man, an air pilot by profession for fourteen years, witnessed an airplane explosion in the air in the middle of the night while on duty at the airport. Two of his friends who were * Submitted

by

ROMEO

J.

LAJOIE,

M.D.,

Los

Angeles,

California.

SEPTEMBER

1960

Following

697

698

Workmen’s

FIG.

An electrocardiogram healed

infarction

(Fig.

of the

1.

1) revealed

anterior

wall

Healed

Compensation

infarction

evidence of the

of left

ventricle.

Comment: The diagnosis was coronary sis with recent coronary anterior there

occlusion

wall which was healed. was

direct

causal

emotional

wall.

disturbance

It was believed between

of the that the

of witnessing

the airplane

plosion and the acute coronary attack. deny pre-existing coronary atherosclerosis.

atherosclero-

and infarction

relationship

of the anterior

ex-

We cannot

REFERENCE

1. SIGLER,

11. Emotional an acute cardiac insult. L.

disturbance

as a cause

.4m. J. Cardiol.,

of 4: 557

1959.

‘THE

AMERICAN

JOURNAL

OF CARDIOLOGY