Past Present and Future Directions in the Treatment of Stress-Related Cardiovascular Disorders

Abstract

The major heart diseases reflect disturbances in the body’s own regulatory mechanisms. Infectious processes—rheumatic fever and sub-acute bacterial endocarditis, formerly very common, no longer predominate among heart patients. Instead people are getting sick and dying because the regulation of cardiovascular metabolism and of the contractile activity of the blood vessels in the heart, the kidney, the brain and elsewhere in the body is disturbed. The consequences include hypertensive or ischemic heart disease, or both. Sudden death may supervene because of a disturbance in the mechanisms that control the heart beat. The basis for perturbation of these regulatory cardiovascular mechanisms may be largely genetic or environmental or a combination of the two. Among pathogenic environmental influences, social and emotional stresses appear to loom large. They may be dealt with by various pharmacologic means as well as psychotherapeutic and behavioral strategies.