WHY ONE
NORMALLY DIED (NEARLY ALWAYS?) BY CARDIOVASCULAR COLLAPSE OR HEART ARREST.
When I was a young assistant in the
psychiatric hospital of P., one thing which amazed me was to find that, in the
compilation of the death certificate, the final cause was invariably a cardiac
arrest or a cardiovascular. The same diction I found, when it came to my
knowledge, in the death certificates made by colleagues of the county general
hospital.
I used to think that a person died for a
specific illness, the latest which had him struck, and that brought him
directly to his fate. I even thought that these dictions were a kind of short
cut not to risking a diagnosis more exactly dealing with the morbid final
cause.
Now, after nearly forty years, I am
convinced that there were exact and
precise definitions, selected by clinical experience, and not based on suitable theoretical reasoning.From a few I
have reached the conviction that, perhaps with the exclusion of fewer cases,
one died for cardiovascular collapse or
for hearth arrest.
It is however interesting notice that both
these events are effects of a hearth
massive vagus stimulation, or a relatively similar one, because now with the
lack of sympathicotonic balancing.Either the cardiovascular collapse, and the
cardiac arrest are however both reactions of stress.
In the home page of this site already in 2000
I wrote about the relationships between Illness and stress, in particular:
1. Any internal
biological-metabolic modification capable to disrupting homeostasis can cause
stress reactions.
2. Every illness can
have symptoms of stress as accompanying symptoms besides
its direct symptoms.
The action on the heart, as the terminal
action of stress, is given by the vagal stimulation coming out from the dorsal nucleus and the ambiguous nucleus, both under the control
of the hypothalamus, which is a structure very sensitive to the stress, and to
the relative neurotransmitters (at least GABA and glutamate).
In the chronic illness, modulating
the stress responses, one could postpone, even if for short time, the last
fate?