Untitled

Abstract

The destruction of the World Trade Center and associated terrorist activities of September 11, 2001 have spurred interest in understanding the medical consequences of terrorist activity. Currently, there is a paucity of data regarding this subject. Potential effects, however, can be garnered by studying the medical effects of other acute stressors, such as earthquakes, missile attacks, and the like. None of these stressors have been studied extensively, but there is enough data available concerning earthquakes to indicate that in some instances, the effects of the earthquake may last at least a period of weeks, if not months, following the earthquake. Since the World Trade Center attack was associated with a rise in post-traumatic stress syndrome and affective disorders afterwards, there is accordingly interest in both the acute and more prolonged health effects that could be engendered following terrorist attacks. Known pathophysiological effects of acute stress, whether produced in a laboratory environment or by studying naturally occurring acute stressors, include: the induction or potentiation of cardiac arrhythmias; the induction of myocardial ischemia in susceptible patients with underlying coronary artery disease; acute increases in arterial blood pressure with its ability to cause shear stress; the precipitation of worsening endothelial function and/or endothelial injury; coagulation abnormalities; and hemoconcentration. These all represent important areas for study following the occurrence of future terrorist activity. Based on existing epidemiological and pathophysiological data concerning the cardiac effects of acute life stressors, it would behoove physicians to closely monitor high-risk cardiac patients following future terrorist events. In addition, physician-scientists should be well prepared to use new epidemiological markers which could provide rapid information following future events, such as the evaluation of patients using pre-versus post-event serum markers or tracing records available among patients fitted with implantable cardiovertor-defibrillators.

Association between feeling threatened by a terrorist attack and subjective health: a web survey a week after the attacks of 22 March 2016 in Belgium

“…However, the most pronounced differences were related to some less prevalent but more alarming health problems: fainting spells, chest pain and shortness of breath. This poses the question of whether such health problems might be related to a rise in myocardial infarctions shortly after terroristic attacks in high-risk individuals, as reported in other studies (Goldberg et al, 2005; Qureshi et al, 2003). …”

“…Especially for people with pre-existing problems, the terrorist threat might be a trigger causing severe problems such as major depression (Neria et al, 2013) and cardiac problems, including myocardial infarction (Goldberg et al, 2005; Qureshi et al, 2003). …”

“…The Worcester Heart Attack study, conducted in a region more than 300 km from New York, suggests that the attacks in New York and on the Pentagon resulted in a significant increase in fatal acute myocardial infarctions (Goldberg et al, 2005; Qureshi, Merla, Steinberg, & Rozanski, 2003). A plausible mechanism linking acute stress responses to cardiac events is that the perceived stress evokes an acute and non-regulated fight-or-flight response that decreases parasympathetic (vagal) tone (Lampert, Baron, McPherson, & Lee, 2002).…”

Mental Stress and Its Effects on Vascular Health

“…Acute stressors can be pinpointed to specific instances. These may be personal, including deaths in the family, 32 and layoffs from work, 33 , 34 both of which have been linked to CVD events, or impersonal, relating to natural disasters such as earthquakes, 35 or manmade disasters such as terrorism, 36 or even from watching World Cup Soccer. 37 Chronic stressors may be discrete and identifiable, and along the lines of Freud’s maxim “happiness comes when one finds pleasure in love and work” can be separated into stressors at home, and those in the workplace ( Figure 1 ).…”