Anger is the affective state most commonly associated with myocardial
ischaemia and infarction and life-threatening arrhythmias, with at lea
st 36 000 (2.4% of 1.5 million) heart attacks precipitated annually by
anger in the United States, Fear, anxiety and bereavement are also im
plicated in increased vulnerability to cardiac events. The lethal card
iovascular consequences of these behavioural stress states in patients
with ischaemic heart disease are attributable to activation of high-g
ain central neurocircuitry and the sympathetic nervous system, provoki
ng acute sinus tachycardia, hypertension, impaired myocardial perfusio
n and cardiac electrical instability. The fields of epidemiology, beha
vioural medicine and cardiovascular physiology have generated new meth
odologies for studying the pathophysiology of anger and other behaviou
ral stress states with the goal of developing means to sever the link
between the anger and its life-threatening consequences.