Abstract
The objective was to identify physiological and behavioral indicators predictive of sudden arrhythmic death in patients who had experienced myocardial infarction in the past.
In a 10-year prospective study of 79 patients, 59 men and 20 women aged 36 to 76 who had suffered a well-documented myocardial infarction (MI) at some time in the past (6 weeks–5 years) were individually matched with healthy controls for age, sex, race, height, weight, educational background and type of job. Both patients and controls were reexamined and retested at intervals of 6-8 weeks throughout the first 7 years of the study.
Fifty-three patients died, 7 of noncardiac disorders, 2 died of suicide. Forty-four, 31 men and 13 women died suddenly of apparent MI. Thirty-one, or 70% of them were autopsied. Eleven were found to have experienced a recent MI and 20 had only an old scar.
Age was not a determinant of cardiac mortality among the patients. The average age of those who died was 56 and of survivors 53. Neither was the level of serum cholesterol concentration, the LDL/HDL ratio, or the treadmill test a significant determinant of death. The measured physiological data that did significantly correlate to the cardiac deaths at the 0.01 level of confidence were low RR variability or wide mean RR variation month to month, prolonged QT interval or wide mean QT variability month to month.
The findings support the view that proper physiological balance requires some degree of instability, but not too little or too much. Walter Cannon in his first paper on homeostasis (Cannon, 1926), credited Charles Richet with this perception “The living being is stable. . . . In a sense it is stable because it is modifiable—the slight instability is the necessary condition for the true stability of the organism” (Richet, 1900).
Similar content being viewed by others
References
Balke, B. (1952). A test of physical performance based on the cardiovascular and respiratory response to gradually increased work. Project No. 21-32-004, Report 1, April, School of Aviation Medicine, Randolph Field, Texas.
Boone, L. Master of Science Thesis. (1967). “A Study of the Relationship Between Oral Behavior, Emotional States and Life Events in Patients with Coronary Heart Disease.” University of Oklahoma Graduate College.
Cannon, W. (1926). Physiological regulation of normal states: Some tentative postulates concerning biological homeostatics. In Charles Richet,Ses Amis, ses Colléques, ses Elèves, Pettit, A (Ed.), Paris: Imperimerie des Editions Médicales, 91–93.
Carlson, A.J., and Meek, W.J. (1908). On the mechanism of the embryonic heart rhythm in limulus.American Journal of Physiology, 21: 1–10.
Dahlstrom, W.G., and Welsh, G.S. (1960). An MMPI handbook: A guide to clinical use and research. University of Minnesota Press, Minneapolis.
Gottshalk, L.A., Gleser, G.C., and Springer, K.J. (1963). Three hostility scales applicable to verbal samples.AMA Archives of General Psychology, 9: 254.
Hampton, J.W., Mantooth, J., and Brandt, E.N. (1968). Plasma fibrinogen patterns in patients with coronary atherosclerosis.Circulation, 34: 1098.
Hildebrandt, G. (1991). Reactive modifications of the autonomous time structure in the human organism.Journal of Physiological Pharmacolology, 42(1): 5–27.
Kleiger, R.E., Miller, J.P., Bigger, J.T., Jr., Moss, A.J., and the Multicenter Post-infarction Research Group. (1987). Decreased heart rate variability and its association with increased mortality after acute myocardial infarction.American Journal of Cardiology, 59: 256–62.
Kristan, W.B. (1980). Generation of Rhythmic Motor Patterns. In H.M. Pinsker and W.D. Willis, (Eds). Information processing in the nervous system. New York, Raven Press, 241–261.
Malik, M., Farrell, T., Cripps, T., Camm, A.J. (1989). Heart rate variability in relation to prognosis after myocardial infarction. Selection of optimal processing techniques.European Heart Journal, 10: 1060–74.
Miller, C.J. (1975). Psychological correlates of coronary artery disease.Psychosomatic Medicine, 27, 3: 257–265, May–June.
Peng, C.K., Buldyrev, S.V., Hausdorff, J.M., Havlin, S., Mietus, J.E., Simons, M., Stanley, H.E., and Goldberger, A.L. (1994). Instability as an indispensable characteristic of a healthy biological system.Integrative Physiological and Behavioral Science, 29, 3: 283–295.
Pinsker, H.M. (1980). Neuroethological analysis of information processing during behavior. In H.M. Pinsker, and W. Willis, (Eds), Information processing in the nervous system, New York: Raven Press.
Richet, C. (1990). Défense, fonctions de.Dictionnaire de Physiologie. Paris: Baillière, 4: 724–745.
Rosenman, R.H., and Friedman, M.A. (1964). A predictive study of coronary heart disease.Journal of the American Medical Association, 189: 15–22.
Scherf, D., and Boyd, L.J. (1946).Clinical Electrocardiography. Philadelphia: Lippincott.
Schneider, R.A., Costiloe, J.P., and Wolf, S. (1971). Arterial pressures recorded in hospital and during ordinary daily activities. Contrasting in subjects with and without ischemic heart disease.Journal of Chronic Diseases, 647–657.
Schwartz, P.J., and Wolf, S. (1987). QT interval prolongation as predictor of sudden death in patients with myocaridal infarction.Circulation, 6: 1074–1077.
Sevelius, G., and Johnson, P.C. (1959a). Blood flow by radio iodinated serum albumen and an externally placed scintillation detector.Southern Medical Journal, 52: 2058.
Sevelius, G., and Johnson, P.C. (1959b). Myocardial blood flow determined by surface counting and ratio formula.Journal of Laboratory and Clinical Medicine, 54: 669.
Theorell, T., Blunk, D., and Wolf, S. (1975). Ballistocardiographic indicators of prognosis in ischemic heart disease.Journal of Laboratory and Clinical Medicine, 86: 46–56.
Valbona, C., Cardus, D., Spencer, W.A., and Hoff, H.E. (1965). Patterns of sinus arrhythmia in patients with lesions of the central nervous system.American Journal of Cardiology, 16: 379–389.
Wenckebach, K.F., and Winterberg, H. (1927). Die Unregelmassige Hertztatigkert. Leipzig: Engelmann.
Wiersma, E.D. (1913). Der Einfluss von Bewusteseinszustünden auf den Puls und auf die. Atmung,Zeit. Ges. Neurol. Psych., 19: 1–24.
Wolf, S. (1958). Cardiovascular reactions to symbolic stimuli.Circulation, 18: 287–292.
Wolf, S. (1967). Neurocardiology.Oklahoma State Medical Journal, 60: 61.
Wolf, S., ed. (1971).The Artery and the Process of Arteriosclerosis: Measurement and Modification. New York: Plenum Press, 213–238.
Wolf, S. (1976). Sinus Arrhythmia: A biological Rhythm with Complex Determinants. In F.J. Pontidas, (Ed.),Honor of Thomas Doxiadis. Hospital Evangelismos, Athens, Greece, 609–614.
Author information
Authors and Affiliations
Additional information
Supported by NIH Research Grant HLB 06286-01-08.
Rights and permissions
About this article
Cite this article
Wolf, S. Oscillatory functions affecting outcome of coronary heart disease: The hazard of too much or too little stability. Integrative Physiological and Behavioral Science 30, 118–126 (1995). https://doi.org/10.1007/BF02691680
Issue Date:
DOI: https://doi.org/10.1007/BF02691680