Sudden Cardiac Death Triggered by an Earthquake

Leor, Jonathan; Poole, W. Kenneth; Kloner, Robert A.

doi:10.1056/nejm199602153340701

Cited by 819Cardiac Health and Mental HealthTakotsubo Cardiomyopathy and Associated PhenomenaCardiac electrophysiology and arrhythmias

Sudden Cardiac Death Triggered by an Earthquake

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Leor, Jonathan, Poole, W. Kenneth, Kloner, Robert A.·1996·New England Journal of Medicine

DOI 10.1056/nejm199602153340701

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Abstract

BACKGROUND: The earthquake that struck the Los Angeles area at 4:31 a.m. on January 17, 1994, was one of the strongest earthquakes ever recorded in a major city in North America. Once the life-threatening situation was over, the Northridge earthquake, so called because its epicenter was near Northridge, California, just north of Los Angeles, provided investigators an unusual opportunity to examine the relation between emotional stress and sudden cardiac death. METHODS: We reviewed the records of the Department of Coroner of Los Angeles County for the week before the earthquake, the day of the earthquake, the six days after the earthquake, and corresponding control periods in 1991, 1992, and 1993. RESULTS: On the day of the earthquake, there was a sharp increase in the number of sudden deaths from cardiac causes that were related to atherosclerotic cardiovascular disease, from a daily average (+/- SD) of 4.6 +/- 2.1 in the preceding week to 24 on the day of the earthquake (z = 4.41, P < 0.001). Sixteen victims of sudden death had symptoms, usually chest pain, or died within the first hour after the initial tremor. Only three sudden deaths occurred during or immediately after unusual physical exertion. During the six days after the earthquake, the number of sudden deaths declined to below the base-line value, to an average of 2.7 +/- 1.2 per day. CONCLUSIONS: The Northridge earthquake was a significant trigger of sudden death due to cardiac causes, independently of physical exertion. This finding, along with the unusually low incidence of such deaths in the week after the earthquake, suggests that emotional stress may precipitate cardiac events in people who are predisposed to such events.

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Cardiovascular changes in the morning may be advantageous in healthy individuals, but could be implicated in precipitating an adverse cardiovascular event in susceptible individuals.
“Such CV changes in the morning may be advantageous in healthy individuals, but could be implicated in precipitating an adverse CV event in susceptible individuals (14)(15)(16)(17).”
From Role of the circadian system in cardiovascular disease (2018) · cites this paper as [15]

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Authors: Leor, J., Poole, W. K., & Kloner, R. A.
Affiliations: University of Southern California (US)
RTI International (US)
ORCID: Leor, Jonathan
Kloner, Robert A.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 1996-02-15
Volume: 334
Issue: 7
Pages: 413-419
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejm199602153340701
OpenAlex: W2329213056
Cited by: 819
References: 22
Citations by year: 2026: 2 · 2025: 9 · 2024: 17 · 2023: 25 · 2022: 24 · 2021: 32 · 2020: 33 · 2019: 25 · 2018: 25 · 2017: 38 · 2016: 34 · 2015: 30 · 2014: 27 · 2013: 40 · 2012: 40
FWCI: 20.26
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Takotsubo Cardiomyopathy and Associated Phenomena
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords: sudden cardiac death, Northridge earthquake, emotional stress, atherosclerotic cardiovascular disease, post-traumatic stress
MeSH terms: Adult, Aged, Aged, 80 and over, Coronary Artery Disease, Disasters, Physical Exertion, Female, Humans, Male, Middle Aged, Stress, Psychological, Los Angeles, Causality, Incidence, Death, Sudden, Cardiac

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