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