Brief Answer:
I would explain as follows:

Detailed Answer:
Hello XXXXXX,

I am glad to hear from you again on HCM!

Regarding your concern, I would explain that it is true that a myocardial infarction (heart attack) can occur during a strong argue. This happens only in persons suffering from coronary artery disease, symptomatic or non symptomatic.

You should know that a strong argue, imposes a big psychological stress to the body, leading to a strong activation of sympathetic nervous system, leading to increased release of chatecholamines (adrenaline and noradrenaline) in blood. These hormones increase the contraction of myocardial muscles and also the heart rate increasing the need for blood (with oxygen and energetic substances) from the myocardial cells. But when coronary arteries are narrowed (like in coronary artery disease), they can not supply the heart with the necessary amount of blood, thus leading to myocardial cell hypoxia and ischemia. When this situation is prolonged (just like during a strong argue), it can lead to death of myocardial cells, also called a heart attack or myocardial infarction.

This is the same what happens during a strenuous physical activity in persons suffering from coronary artery disease.

Both psychological and physical stress can lead to myocardial infarction with the same pathological mechanisms in coronary artery disease patients.

The risk factors that lead to MI after a strong argue are the same risk factors that lead to coronary artery disease (also called cardio-vascular risk factors) including:

-smoking and alcohol
-arterial hypertension
-obesity and sedentary life
-dyslipidemia (high cholesterol levels)
-family history
-diabetes, etc.

Hope to have clarified some of your uncertainties.

Feel free to ask any other questions whenever you need!

Best wishes,

Dr. Iliri

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