Occupational Medicine: State of the Art Reviews; Chapter 4: The Central Nervous System: Bridge between the External Milieu and the Cardiovascular System Authors: Stewart Wolf and Karen Belkic
The concept of neurocardiology, introduced as an interdisciplinary area linking the neurosciences and cardiology, is expanded into a tripartite construct, which includes the environment as the potential stressor: “econeurocardiology”. Experimental animal studies provide empirical grounding for this construct; therein central stress mechanisms are implicated in cardiac electrical instability, as well as in hypertension, abnormalities of heart beat dynamics and atherogenesis. The defense response appears to play an important role in these processes, with the defeat reaction being activated in chronic stress, especially of a severe nature. In the worst case, both are operative: the defense-defeat response, activating the sympatho-adrenomedullary and hypophyseal-adrenocortical pathways, respectively. This appears to be a particularly deleterious combination for the cardiovascular system.