In-Hospital Cardiac Arrest after Emotional Stress in a Patient Hospitalized with Gastrointestinal Symptoms and Chronic Anxiety Disorder

Background: We report an acute emotional stress–induced in-hospital cardiac arrest in a patient admitted with gastrointestinal symptoms after experiencing chronic anxiety disorder.Case Presentation: The patient was admitted to the Second Xiangya Hospital, Central South University, withgastrointestinal symptoms and chronic anxiety disorder, and experienced cardiac arrest during hospitalization after acute emotional stress. Malignant ventricular tachycardia and cardiogenic shock were evidenced in this patient afterthe acute emotional stress. Severe and extensive coronary spasm was confirmed by emergency coronary angiography, and coronary spasm was relieved by intracoronary injection of nitroglycerin. The patient recovered from myocardial infarction with nonobstructive coronary arteries. However, the patient developed acute kidney dysfunction and severe pulmonary infection and eventually died of respiratory circulatory failure on the ninth day after the successful rescue.Conclusions: Acute emotional stress on top of chronic anxiety disorder in patients hospitalized for noncardiovascularreasons might lead to the development of life-threatening cardiovascular diseases, including coronary artery spasmand myocardial infarction with nonobstructive coronary arteries. Psychological management is of importance to improvethe outcome of these patients.

Impact of Acute Emotional Stress on the Tear Quality of Students from a Medical School in Campina Grande: Paraiba Brazil

Background: Stress acts on the nervous system impairing lachrymal gland function. Thus, one can hypothesize that medical students under academic evaluation, with acute emotional stress, could suffer changes in tear quality, which was the purpose of this study.Methods: The prospective, longitudinal, observational and analytic study was performed at Faculty of Medical Sciences-Campina Grande, Paraíba, Brazil. It was randomly recruited, 80 (5.8%) students, 42 (52.5%) women and 38 (47.5%) men, with ages ranging from 18 to 42 year-old (22.9 ± 4.9 years), median of 21.5 years. Exclusion criteria include all students who presented with any disease or condition that could affect the tear quality. The BUT was assessed before and after 35 days of academic examination. The continuous parameters were expressed by their mean ± standard deviation. Wilcoxon test was used for assessing difference between means. P ≤ 0.05 was used for rejecting the null hypothesis. The research was approved by the Institutional Ethics Committee.Results: Stress was present in all students immediately of taking academic evaluation; ranging as follows: mild-15 (18.7%); moderate-41 (51.3%), and severe 24 (30.0%) (How was this stress assessed to arrive at mild, moderate and severe). The mean BUT in the right eye was significantly higher after the 35-day interval (before 8.5 ± 3.1 seconds versus 9.6 ± 3.0 seconds - p = 0.0016). Similarly, the mean BUT in the left eye was significantly higher after the 35-day interval (before 8.5 ± 3.1 seconds versus 9.4 ± 2.9 seconds - p = 0.0053.Conclusion: There was a decrease in the BUT immediately before academic evaluation. However, there was nocorrelation or association with the stressful parameters caused during this period with the BUT measurements,including emotional stress levels, night sleep time before academic examination. It was observed a tendency to return to BUT baseline parameters, later 45 days after knowledge of student performance in the academic examinations.