A state of 'vital exhaustion', characterized by unusual tiredness, inc
reased irritability and feelings of demoralization has been found to p
receed the onset of myocardial infarction and to increase :he risk of
a new coronary event after angioplasty. Probably this state reflects a
decreased activity of the hypothalamic-pituitary-adrenal axis as part
of an homeostatic reaction to prolonged stress and inflammation.