The Emotional, Environmental, Physical and Chemical Triggers of Acute Myocardial Infarction: An Analytical Demographic Study

  • Majid Pourshaikhian Social Determinants of Health Research Centre, Guilan University of Medical Sciences, Rasht, Iran
  • Mohammad Taghi Moghadamnia Social Determinants of Health Research Centre, Guilan University of Medical Sciences, Rasht, Iran
  • Maryam Ghiasmand Guilan Social Security Organization
Keywords: Demography, acute triggers, myocardial infarction


Objective: Acute triggers are external stimuli that produce acute pathophysiologic changes directly leading to the onset of myocardial infarction (MI). Acute myocardial infarction (AMI) is one of the main causes of mortality. Recent studies have confirmed the impact of acute triggers on the occurrence of AMI, but have not evaluated their differences in terms of demographic characteristics. This study was conducted to investigate the impact of acute triggers on AMI in various demographic groups. Methods: This is an analytical cross-sectional study on 269 patients affected by AMI in two hospitals in 2015 and 2016 in Iran. To attain the goals of the study, acute triggers were divided into four groups of emotional, environmental, physical, and chemical. A researcher-developed questionnaire and interview were used to collect data. The risk and control periods were also evaluated for each trigger. The data were analyzed by descriptive statistics and inferential statistics such as statistical logistic regression and McNemar’s test using SPSS 21. The P-value was set at 0.05. Results: The results showed that sudden exposure to hot/cold weather in men (P=0.03, OR=3.4), underlying diseases (P=0.03, OR=1.8), heavy activities (P=0.03, OR=1.6) and consuming tea/coffee in men (P=0.01, OR=1.8) increased the chance of AMI. It was also discovered that triggers such as pulmonary infections, overeating and/or eating high-fat foods that are not dependent on demographic variables promoted the chance of AMI (P<0.05). Conclusion: All people - regardless of age, sex, and the presence/lack of underlying illness - are at risk of developing MI in the face of respiratory infections, overeating, and intake of high-fat foods. Also, sudden exposure to hot and / or cold weather, heavy activity and high consumption of coffee and/or tea, can increase the risk of MI in men.

Author Biographies

Majid Pourshaikhian, Social Determinants of Health Research Centre, Guilan University of Medical Sciences, Rasht, Iran
Department of Operation room & Anesthesia
Mohammad Taghi Moghadamnia, Social Determinants of Health Research Centre, Guilan University of Medical Sciences, Rasht, Iran
Department of Nursing
Maryam Ghiasmand, Guilan Social Security Organization
Critical Care Nursing Department


Brunner LS, Smeltzer SC, Bare BG, Hinkle JL, Cheever KH. Brunner & Suddarth's textbook of medical-surgical nursing. 12nd ed. Philadelphia: Lippincott Williams & Wilkins; 2010. p.17-22.

Beyranvand M-R, Lorvand A, Parsa SA, Motamedi M-R, Kolahi A-A. The quality of life after first acute myocardial infarction. Pajoohandeh J. 2011;15:264-72.

Ahmadi A, Khaledifar A, Sajjadi H, Soori H. Relationship between risk factors and in-hospital mortality due to myocardial infarction by educational level: a national prospective study in Iran. Int j equal health. 2014;13:116.

Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Executive summary: heart disease and stroke statistics-2012 update. A report from the American Heart Association. Circulation. 2012;125:188-197.

Čulić V, Eterović D, Mirić D, Rumboldt Z, Hozo I. Gender differences in triggering of acute myocardial infarction. Am J Cardiol. 2000;85:753-6..

Schwartz B, French W, Mayeda G, Burstein S, Economides C, Bhandari A, et al. Emotional stressors trigger cardiovascular events. Int J Clin Pract. 2012;66:631-9.

Čulić V. Acute risk factors for myocardial infarction. Int J Cardi. 2007;117:260-9.

Masoomi M, Zare J, Kahnooj M, Mirzazadeh A, Sheikhvatan M. Sex differences in potential daily triggers of the onset of acute myocardial infarction: a case-crossover analysis among an Iranian population. J Cardiovasc Med. 2010;11:723-6.

Colombo A, Proietti R, Culic V, Lipovetzky N, Viecca M, Danna P. Triggers of acute myocardial infarction: a neglected piece of the puzzle. J Cardiovasc Med. 2014;15:1-7.

Glozier N, Tofler GH, Colquhoun DM, Bunker SJ, Clarke DM, Hare DL, et al. Psychosocial risk factors for coronary heart disease. Med J Aust. 2013;199:179-80.

Laušević M, Jovanović N, Bontić A, Stojimirović B. Hypertension in peritoneal dialysis patients. Medicinski pregled. 2006;59:130-4.

Strike PC, Steptoe A. Behavioral and emotional triggers of acute coronary syndromes: a systematic review and critique. Psychosom Med. 2005;67:179-86.

Mittleman MA, Mostofsky E. Physical, psychological and chemical triggers of acute cardiovascular events. Circulation. 2011;124:346-54.

Lanki T, Pekkanen J, Aalto P, Elosua R, Berglind N, D’Ippoliti D, et al. Associations of traffic related air pollutants with hospitalisation for first acute myocardial infarction: the HEAPSS study. Occup environ med. 2006;63:844-51.

Warren-Gash C, Hayward AC, Hemingway H, Denaxas S, Thomas SL, Timmis AD, et al. Influenza infection and risk of acute myocardial infarction in England and Wales: a Caiber self-controlled case series study. J Infect Dis. 2012:jis597.

Moghadamnia MT, Ardalan A, Mesdaghinia A, Keshtkar A, Naddafi K, Yekaninejad MS. Ambient temperature and cardiovascular mortality: a systematic review and meta-analysis. PeerJ. 2017;5:e3574.

Lin Y-K, Wang Y-C, Lin P-L, Li M-H, Ho T-J. Relationships between cold-temperature indices and all causes and cardiopulmonary morbidity and mortality in a subtropical island. Sci Total Environ. 2013;461:627-35.

Bhaskaran K, Armstrong B, Hajat S, Haines A, Wilkinson P, Smeeth L. Heat and risk of myocardial infarction: hourly level case-crossover analysis of MINAP database. Brit Med J. 2012;345:e8050.

Mostofsky E, Penner EA, Mittleman MA. Outbursts of anger as a trigger of acute cardiovascular events: a systematic review and meta-analysis. Eur Heart J. 2014:ehu033.

Edmondson D, Newman JD, Whang W, Davidson KW. Emotional triggers in myocardial infarction: do they matter? Eur Heart J. 2012:ehs398.

Buckley T, Hoo SYS, Fethney J, Shaw E, Hanson PS, Tofler GH. Triggering of acute coronary occlusion by episodes of anger. Eur Heart J: Acute Cardiovascular Care. 2015;4:493-8.

Baylin A, Hernandez-Diaz S, Kabagambe EK, Siles X, Campos H. Transient exposure to coffee as a trigger of a first nonfatal myocardial infarction. Epidemiology. 2006;17:506-11.

Original Research