1
|
von Känel R. Stress-Induced Hypercoagulability: Insights from Epidemiological and Mechanistic Studies, and Clinical Integration. Semin Thromb Hemost 2024. [PMID: 38914118 DOI: 10.1055/s-0044-1787660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
By integrating findings from comprehensive reviews, meta-analyses, and cutting-edge genetic studies, this article illuminates the significance of stress-induced hypercoagulability in clinical medicine. In particular, the findings from numerous prospective cohort studies indicate that stress and hemostatic factors of a hypercoagulable state are associated with increased incident risk and poor prognosis for atherosclerotic cardiovascular disease and venous thromboembolism. Mendelian randomization studies suggest that these associations are partially causal. The review synthesizes extensive research on the link between acute and chronic stress and hypercoagulability, outlining a potential pathway from stress to thrombosis risk. Consistent with the allostatic load concept, acute stress-induced hypercoagulability, initially adaptive, can turn maladaptive under chronic stress or excessive acute stress, leading to arterial or venous thrombotic events. Individuals with predisposing factors, including atherosclerosis, thrombophilia, or immobilization, may exhibit an increased risk of thrombotic disease during stress. Contextual sociodemographic characteristics, the stress experience, and coping resources additionally modulate the extent of stress-induced hypercoagulability. Research into the neuroendocrine, cellular, and molecular bases reveals how stress influences platelet activation coagulation and fibrinolysis. The activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, along with vagal withdrawal, and the effects of catecholamines, cortisol, and vasopressin, are the central mechanisms involved. Hemoconcentration, inflammation, endothelial dysfunction, and thrombopoiesis additionally contribute to stress-induced hypercoagulability. Further research is needed to prove a causal link between chronic stress and hypercoagulability. This includes exploring its implications for the prevention and management of thrombotic diseases in stressed individuals, with a focus on developing effective psychosocial and pharmacological interventions.
Collapse
Affiliation(s)
- Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
2
|
Abed Alah M, Abdeen S, Selim N. Healthy Minds for Healthy Hearts: Tackling Stress-Induced Cardiac Events During the FIFA World Cup 2022. Vasc Health Risk Manag 2022; 18:851-856. [PMID: 36510577 PMCID: PMC9741484 DOI: 10.2147/vhrm.s390549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/22/2022] [Indexed: 12/07/2022] Open
Abstract
Millions of people are looking forward to the biggest event this year "FIFA World Cup 2022" taking place in the state of Qatar. This event is an opportunity for people around the world to socialize, connect, celebrate, and enjoy watching football matches. However, the emotional stress experienced by football players and fans during a such major sport event can sometimes result in unfavorable physiological responses that can adversely affect the heart leading to adverse cardiac consequences. In this mini-review, we summarized the evidence and pathophysiology of stress-induced cardiac events during football games, and the potential strategies to prevent stress-induced cardiac events during the FIFA World Cup 2022.
Collapse
Affiliation(s)
- Muna Abed Alah
- Community Medicine Department, Hamad Medical Corporation (HMC), Doha, Qatar,Correspondence: Muna Abed Alah, Email
| | - Sami Abdeen
- Community Medicine Department, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Nagah Selim
- Community Medicine Department, Primary Health Care Corporation, Doha, Qatar,Public health and Preventive medicine department, Cairo University, Cairo, Egypt
| |
Collapse
|
3
|
Meyer T, Demond V, Scharhag J. Cardiocirculatory Stress in Professional Football (Soccer) Coaches. Clin J Sport Med 2022; 32:414-417. [PMID: 35762864 PMCID: PMC9223509 DOI: 10.1097/jsm.0000000000001013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 12/17/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE It was intended to quantify cardiocirculatory stress and risk of professional football (soccer) coaches during competition. DESIGN Descriptive cross-sectional study. SETTING Medical screening examination and measurements during match. PARTICIPANTS Seventeen coaches and 11 assistant coaches of the 2 highest German football leagues (male coaches; 46 ± 7 years; 8 ± 7 years in job). INDEPENDENT VARIABLES Professional football matches with highly competitive character were chosen and monitored for elicited cardiocirculatory stress and possible damage. MAIN OUTCOME MEASURES Indicators of general health status, occurrence of arrhythmias, and course of heart rate and cardiac biomarkers (brain natriuretic peptide [BNP], troponin I) during the match. RESULTS Besides a few preexisting cardiovascular diseases, medical screening revealed a risk factor profile similar to the general population and above-average maximal/submaximal cycle ergometry performance: Pmax 2.9 ± 0.5 W*kg-1; PWC130 1.9 ± 0.5 W*kg-1. No match-induced changes were detected for BNP (20.5 ± 9.4 to 19.7 ± 10.7 pg/mL; P = 0.48) and troponin I (12.6 ± 16.5 to 10.5 ± 14.1 ng/L; P = 0.31). Maximal heart rate during the first and second half was 127 ± 15 and 132 ± 19 beats per minute, respectively. No match-induced arrhythmias of higher degree were detected. CONCLUSIONS Head and assistant coaches of German professional football teams do not show any match-induced cardiac damage, despite considerable cardiocirculatory stress. Possibly, their above-average fitness level saves them from more detrimental outcomes.
Collapse
Affiliation(s)
- Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany; and
| | - Vera Demond
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany; and
| | - Jürgen Scharhag
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany; and
- Sports Medicine, Exercise Physiology and Prevention, University Vienna, Austria
| |
Collapse
|
4
|
Xie YJ, Wang S, Gong QJ, Wang JX, Sun FH, Miyamoto A, Ou X, Wang L, Wang SQ, Zhang C. Effects of electromyography biofeedback for patients after knee surgery: A systematic review and meta-analysis. J Biomech 2021; 120:110386. [PMID: 33794414 DOI: 10.1016/j.jbiomech.2021.110386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 01/10/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
There has been no systematic review evaluating the efficacy of electromyography (EMG) biofeedback after knee surgery recently. This meta-analysis aimed to determine whether EMG-biofeedback is effective for improving the range of motion (ROM), physical function, and pain relief in patients after knee. Randomized controlled trials (RCTs) assessing the effect of EMG-biofeedback after any knee surgery were retrieved from EMBASE, PubMed, Cochrane Library, Physiotherapy Evidence Database, ClinicalTrials.gov, ProQuest. This review identified 773 unique studies, and six RCTs were in the final meta-analysis. EMG-Biofeedback treatment has a significant difference compared to other rehabilitation therapy in knee ROM improving (SMD = -0.48, 95% CI = -0.82 to -0.14, p = 0.006, I2 = 37%). Moreover, there was no significant difference in pain (SMD = -0.33, 95% CI = -0.67 to0.02, p = 0.07, I2 = 41%) and physical function scores (MD = 1.83, 95% CI = -3.48 to7.14, p = 0.50, I2 = 0%). The results illustrate that EMG-biofeedback can improve knee ROM in patients after knee surgery. However, it is not superior to other rehabilitation methods for pain relief and physical function improvement.
Collapse
Affiliation(s)
- Yu-Jie Xie
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Shuang Wang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Qun-Jie Gong
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Jian-Xiong Wang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Fu-Hua Sun
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Akira Miyamoto
- Department of Physical Therapy Faculty of Rehabilitation of Kobe International University, Japan
| | - Xia Ou
- Nuclear Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Li Wang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Shi-Qi Wang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Chi Zhang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.
| |
Collapse
|
5
|
Allison MC, Doyle NA, Greene G, Mahmood A, Glickman M, Jones AK, Mizen PE. Lockdown Britain: Evidence for reduced incidence and severity of some non-COVID acute medical illnesses. Clin Med (Lond) 2021; 21:e171-e178. [PMID: 33762383 PMCID: PMC8002805 DOI: 10.7861/clinmed.2020-0586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Large reductions in emergency department attendances and hospitalisations with non-COVID acute medical illness early during the pandemic were attributed to reluctance to seek medical help and higher referral thresholds. Here, we compare acute medical admissions with a comparison cohort from 2017. Deaths in the same geographic area were examined, and Wales-wide deaths during these 4 weeks in 2020 were compared with a seasonally matched period in 2019. There were 528 patients admitted with non-COVID illness in 2020, versus 924 in 2017 (a reduction of 43%). Deaths from non-COVID causes increased by 10.9% compared with 2017, over half this rise being from neurological causes including stroke and dementia. While far fewer patients required hospitalisation as medical emergencies, rises in local non-COVID deaths proved small. Wales-wide non-COVID deaths rose by just 1% compared with 2019. The findings suggest that changes in population behaviour and lifestyle during lockdown brought about unforeseen health benefits.
Collapse
Affiliation(s)
| | | | | | - Arif Mahmood
- Aneurin Bevan University Health Board Headquarters, Newport, UK
| | - Myer Glickman
- methods and international, Office for National Statistics, Newport, UK
| | | | | |
Collapse
|
6
|
Maturana MA, Glover EA, Raja J, Dornbush SR, Alexander J, Blount C, Khouzam NR, Khouzam AR, Khouzam RN. Are Die-Hard Football or Other Sports Fans at Risk of Cardiovascular Events? Curr Probl Cardiol 2020; 46:100743. [PMID: 33280894 DOI: 10.1016/j.cpcardiol.2020.100743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/04/2020] [Indexed: 11/25/2022]
Abstract
Trigger factors such as earthquakes, war, and terrorism have been shown to increase the risk of cardiovascular events in different studies. Similarly, strong emotions and psychological stress have been associated with myocardial infarction, symptomatic arrhythmias, and sudden cardiac death. Die-hard soccer, rugby, football, and baseball fans seem to be at risk of cardiac events, particularly in individuals with prior history of coronary artery disease. Transient hemodynamic changes, endothelial dysfunction, and an overwhelming sympathetic nervous system stimulation appear to affect cardiac hemostasis creating a procoagulant and arrhythmogenic environment. High-risk behaviors such as tobacco abuse and binge drinking appear to contribute to this risk generating a proinflammatory state characterized by elevated levels of endothelin-1 and overexpression of sCD40L, sVCAM-1, MCP-1, and TNF-alpha. The outcome of the game and unexpected results, especially among fans of the defeated team, seem to further correlate with adverse cardiovascular effects.
Collapse
Affiliation(s)
- Miguel A Maturana
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN.
| | - Elizabeth A Glover
- University of Tennessee Health Science Center, College of Medicine, Memphis, TN
| | - Joel Raja
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Sean R Dornbush
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - John Alexander
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Courtland Blount
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN
| | | | | | - Rami N Khouzam
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN
| |
Collapse
|
7
|
Slagman A, Behringer W, Greiner F, Klein M, Weismann D, Erdmann B, Pigorsch M, Möckel M. Medical Emergencies During the COVID-19 Pandemic. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:545-552. [PMID: 32865489 DOI: 10.3238/arztebl.2020.0545] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/18/2020] [Accepted: 07/06/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND In this study, we investigate the number of emergency room consultations during the COVID-19 pandemic of 2020 in Germany compared to figures from the previous year. METHODS Case numbers from calendar weeks 1 through 22 of the two consecutive years 2019 and 2020 were obtained from 29 university hospitals and 7 non-university hospitals in Germany. Information was also obtained on the patients' age, sex, and urgency, along with the type of case (outpatient/inpatient), admitting ward, and a small number of tracer diagnoses (I21, myocardial infarction; J44, COPD; and I61, I63, I64, G45, stroke /TIA), as well as on the number of COVID-19 cases and of tests performed for SARS-CoV-2, as a measure of the number of cases in which COVID-19 was suspected or at least included in the differential diagnoses. RESULTS A total of 1 022 007 emergency room consultations were analyzed, of which 546 940 took place in 2019 and 475 067 in 2020. The number of consultations with a positive test for the COVID-19 pathogen was 3122. The total number of emergency room consultations in the observation period was 13% lower in 2020 than in 2019, with a maximum drop by 38% coinciding with the highest number of COVID-19 cases (calendar week 14; 572 cases). After the initiation of interpersonal contact restrictions in 2020, there was a marked drop in COVID-19 case numbers, by a mean of -240 cases per week per emergency room (95% confidence interval [-284; -128]). There was a rise in case numbers thereafter, by a mean of 17 patients per week [14; 19], and the number of cases of myocardial infarction returned fully to the level seen in 2019. CONCLUSION In Germany, the COVID-19 pandemic led to a significant drop in medical emergencies of all kinds presenting to the nation's emergency departments. A recovery effect began to be seen as early as calendar week 15, but the levels seen in 2019 were not yet reached overall by calendar week 22; only the prevalence of myocardial infarction had renormalized by then. The reasons for this require further investigation.
Collapse
Affiliation(s)
- Anna Slagman
- Departments of Emergency and Acute Medicine, Campus Mitte and Virchow-Klinikum Charité-Universitätsmedizin Berlin
| | | | - Felix Greiner
- AKTIN Emergency Department Registry and Department of Trauma Surgery, Otto-von-Guericke University Magdeburg
| | - Matthias Klein
- Central Emergency Department, Klinikum Großhadern, Ludwig-Maximilians Universität München
| | - Dirk Weismann
- Department of Internal Emergency and Intensive Care Medicine and Department of Internal Medicine I, University Hospital Würzburg
| | | | - Mareen Pigorsch
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin
| | - Martin Möckel
- Departments of Emergency and Acute Medicine, Campus Mitte and Virchow-Klinikum Charité-Universitätsmedizin Berlin
| | | | | |
Collapse
|