Emotional stress is one of the important risk factors associated with coronary atherosclerosis and acute myocardial infarction. The initial event in the formation of an atherosclerotic plaque may be a mural platelet aggregate forming on the endothelial surface of an artery; and the final event in myocardial infarction may be the plugging of a narrowed area of a coronary vessel by an inappropriately forming intravascular platelet aggregate. To study the effect of emotional stress on platelet function, 14 normal interns and residents were studied immediately before, immediately after, and 7 days after presenting a case before a large critical group of attending physicians. Response of platelet rich plasma to ADP and epinephrine was determined using a Chronolog aggregometer. In eleven subjects the rate of first phase aggregation, the percent total aggregation and the length of the plateau phase with epinephrine indicated significantly inhibited platelet function immediately after stress as compared to the baseline study 7 days later. Eight subjects responded similarly to ADP. In 4 subjects similarly decreased function occurred in the prestress (anticipation) period. It is concluded that emotional stress has a profound effect on platelet function, an effect that may suggest that platelets aggregate intra-vascularly during stress, deaggregate, and then are relatively insensitive to aggregation immediately after the stress period.
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