Can emotional stress lead to an aortic dissection?

Severe Physical and Emotional Stress May Cause Catastrophic Tear in Aorta

November 01, 2007

by Office of Public Affairs & Communications

Intense physical exertion or an extreme emotion, like shoveling snow or anxiety over big gambling losses, can cause a rupture in the main artery leading to and from the heart, according to a Yale School of Medicine study in the American Journal of Cardiology.

This damage to the inner wall of the aorta is known as an aortic dissection (ADD), in which a tear in the wall creates two channels. The blood continues to travel in one channel but is stagnant in the other, causing the rupture to balloon and push on other branches of the aorta, constricting their blood flow. The condition can be fatal.

The senior author of the study, John Elefteriades, M.D., section chief of cardiothoracic surgery, said an increase in blood pressure can lead to a dissection, but the events that might precipitate the underlying hypertension are not well understood.

To answer this question, Elefteriades and his co-authors interviewed 90 patients who had an aortic dissection and asked what happened right before the rupture occurred. Sixty-seven percent identified either severe exertion or severe emotion as a trigger for their ADD.

More specifically, 24 patients said they were involved in activities such as lifting weights or other heavy objects, shoveling snow, changing storm windows, playing racquet ball, doing push ups, or engaging in vigorous sex. Thirty-six patients said they had just experienced a severe emotional blow—including upsetting news, such as a diagnosis of lung cancer, experiencing big losses at the casino, and taking a stressful business trip.

“The aorta degenerates over time and becomes more dilated, which increases stress on the aortic wall,” Elefteriades said. “Severe physical or emotional stress increases blood pressure to the point where the tensile limit of the aortic tissue is overwhelmed, causing the rupture.”

American Journal of Cardiology 100: 1470-1472 (November 1, 2007)

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