ESC HOT LINE COMMENTARY Earthquakes: another cause of heart failure?

The role of acute stress in triggering cardiac events, especially in vulnerable individuals, is no longer disputed. The consequences of an acute and unexpected stressor have been examined during earthquakes, providing a population-based sampling methodology, the known exact timing of the stressor, and tabulation of acute cardiac events before and after the event. The first study by Leor et al. was conducted in the wake of the Northridge earthquake which occurred at 04:31 h on 17 January 1994, one of the strongest earthquakes ever recorded. The authors reviewed the daily mortality and determined the underlying causes of death for the 7-day period before the earthquake, the day of the quake, and 6 days thereafter. Data were compared with the corresponding period in 1991, 1992, and 1993. On the day of the earthquake, there was a sharp increase in sudden cardiac deaths immediately after the earthquake compared with the week before and after the earthquake, and with the corresponding control periods. Deaths typically occurred among people with advanced coronary atherosclerosis. Leor et al. conclude that this finding, along with the unusually low incidence of such deaths in the week after the earthquake, suggests that emotional stress may trigger cardiac emergencies in people who are predisposed to such events. Suzuki and colleagues analysed the occurrence of acute myocardial infarction (AMI) during the Hanshin-Awaji earthquake in the Kobe region on 17 January 1995. The authors investigated the weekly frequency of MI and defined a 7-week period: 2 weeks before the earthquake, the week in which the earthquake took place, and 4 weeks after the quake. Data were compared with the corresponding period in 1992–1994. An increase in the number of patients admitted for AMI was reported in the week the earthquake took place (17–23 January 1995) and returned to normal 4 weeks after the quake. Nakagawa and colleagues have studied the long-term effect of the Niigata-Chuetsu earthquake which took place on 23 October 2004 on AMI mortality. The authors examined death certificate data for all those who died in the area between 1 October 1999 and 30 September 2007. In the disaster area, the mortality rate of men and women increased significantly for 3 years after the earthquake compared with 5 years before the quake. The authors conclude that clinicians and policymakers should be aware of the need to provide long-term prevention of AMI among those living in earthquake areas. Tsuchida et al. addressed the impact of the Noto Peninsula earthquake in Japan on 25 March 2007 on the occurrence of acute coronary syndrome (ACS) and stroke. The authors investigated patients who were admitted to hospital from 25 March to 29 April 2007. Data were compared with the same period in the previous 3 years. The first case of ACS occurred 15 min after the earthquake, and the first case of stroke 72 h after the event. During the 35 days after the earthquake, among 49 patients who were attended by the local ambulance, five patients with ACS (10.2%) and eight with stroke (16.3%) were documented. The total number of cases was significantly increased compared with the control period. In a population-based study in the greater Munich area, we could demonstrate that not only a natural catastrophe but also intense strain and emotional pressure watching the national team playing in an important football match may trigger acute cardiac emergencies. The World Cup was held in Germany from 9 June to 9 July 2006, the prospectively assessed study period. The periods of 1 May to 8 June and 10 July to 31 July in 2005 and 2003, as well as 1 May to 8 June and 10 July to 31 July 2006, constituted the control periods. Patients who had contacted emergency services, had been evaluated by an emergency medicine physician, and had been given the diagnosis ACS or symptomatic cardiac arrhythmias up to cardiac arrest were studied. We found a significant increase in the incidence of ACS and symptomatic cardiac arrhythmias within 2 h of matches in which the German team played compared with matches without German participation and compared with a control period, especially in men with known coronary heart disease. This major increase is exemplified during a very dramatic game which included a penalty shoot-out (Germany beat