Vital Exhaustion

Definition

Vital exhaustion is a prodromal constellation of symptoms including physical exhaustion and feelings of hopelessness preceding major coronary heart disease events such as myocardial infarction.

Description

Vital exhaustion was a concept first proposed by Appels some 25 years ago. Appels argued that exhaustion was not simply premonitory to cardiac events, reflecting established pathology and representing early warnings, the historic clinical view. Rather, he contended that the syndrome of vital exhaustion was casually related to subsequent events. The causal pathway was hypothesized to be the neuroendocrine mechanisms typically invoked as the link between psychosocial exposures and heart disease. Support for a causal role for vital exhaustion was gleaned from a number of subsequent observational epidemiological studies demonstrating an association between measure of exhaustion and subsequent all-cause mortality and cardiac disease mortality and morbidity. Unfortunately, such...