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Cited by 304Cardiovascular Syncope and Autonomic DisordersCardiac Health and Mental HealthCardiac electrophysiology and arrhythmias

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Psychologic Stress, Vasodepressor (Vasovagal) Syncope, and Sudden Death

ENGEL, GEORGE L.·1978·Annals of Internal Medicine
DOI 10.7326/0003-4819-89-3-403
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Abstract

Giving up in the face of emotional arousal and psychologic uncertainty are conditions conducive both to vasodepressor syncope and sudden death. Under such circumstances there may be simultaneous activation of two emergency biologic regulatory systems, flight-fight and conservation-withdrawal. In the healthy person this may result in vasodepressor syncope, benign arrhythmias, or both. In the presence of factors lowering the threshold for conduction disturbances, dangerous arrhythmias and sudden death rather than, or as well as, vasodepressor syncope may result. Although active myocardial damage by itself may provide the necessary and sufficient conditions for lethal arrhythmias, psychic uncertainty must be considered an additional risk factor. The implications of this concept for patient care and prevention of sudden death are a challenge for future research.

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  • The typical BII response pattern described in the literature comprises two phases: an initial increase in heart rate and blood pressure, and a subsequent sharp fall in heart rate and blood pressure leading to reduced cerebral blood flow and fainting.

    “The typical response pattern has been described in the literature as an event comprising two phases, the diphasic (alternatively, using the Latin prefix: biphasic) response (e.g., Engel, 1978; Kozak and Montgomery, 1981; Thyer and Curtis, 1985).”

    From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Engel, 1978

  • Common knowledge in this area draws heavily on earlier research on emotional fainting and textbook entries for BII phobia tend to focus strongly on fainting and the diphasic response pattern as fundamental characteristics.

    “Consequently, common knowledge in this area draws heavily on earlier research on emotional fainting (Engel, 1978; Graham et al., 1961) and textbook entries for BII phobia tend to focus strongly on fainting and the diphasic response pattern as fundamental characteristics of this disorder (Barlow & Durand, 2005).”

    From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Engel, 1978

  • The underlying pattern of autonomic regulation in BII phobia has been characterized as a diphasic response, with initial increases in heart rate and blood pressure typical of fight-flight and subsequent drops in blood pressure and/or heart rate that may precipitate vasovagal fainting.

    “The underlying pattern of autonomic regulation has been characterized as a diphasic response, with initial increases in heart rate and blood pressure that are typical of a fight-flight response, and subsequent drops in blood pressure and/or heart rate that may precipitate vasovagal fainting.”

    From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Engel, 1978

  • Lack of the second phase of the diphasic response may be due to brief exposures, as a number of patients develop pre-syncopal symptoms only after a few minutes.

    “For example, lack of the second phase of the diphasic response may be due to brief exposures: Lumley and Melamed (1992) used a film presentation as short as 60-s, which may have been too short as a number of patients develop pre-syncopal symptoms only after a few minutes (Engel, 1978).”

    From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Engel, 1978

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Metadata

Authors
ENGEL, G. L.
Affiliations
Rochester, New York
Corresponding author
ENGEL, GEORGE L.
Venue
Annals of Internal Medicine
Publisher
American College of Physicians
Published
1978-09-01
Volume
89
Issue
3
Pages
403-412
ISSN
  • 0003-4819 (ISSN-L)
  • 1539-3704
DOI
10.7326/0003-4819-89-3-403
OpenAlex
W2003400453
Cited by
304
References
0
Citations by year
2026: 1 · 2025: 3 · 2024: 1 · 2023: 3 · 2022: 2 · 2021: 2 · 2020: 3 · 2019: 5 · 2018: 3 · 2017: 7 · 2016: 5 · 2015: 3 · 2014: 8 · 2013: 7 · 2012: 5
FWCI
6.50
Type
journal article
Language
en
Open access
closed
Licence
www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations
  • Annals of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords
psychological stress, vasovagal syncope, sudden death, emotional arousal, cardiac arrhythmias, cardiac conduction disorders, myocardial injury, sudden death prevention
MeSH terms
Adult, Animals, Haplorhini, Arrhythmias, Cardiac, Death, Sudden, Dogs, Electroshock, Escape Reaction, Female, Humans, Male, Middle Aged, Social Behavior, Stress, Psychological, Swine, Syncope

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