GEORGE L. ENGEL
The life settings in which sudden death may occur can be classified into eight categories:  on the impact of the collapse or death of a close person;  during acute grief;  on threat of loss of a close person;  during mourning or on an anniversary;  on loss of status or self-esteem;  personal danger or threat of injury;  after the danger is over;  reunion, triumph, or happy ending. Common to all is that they involve events impossible for the victims to ignore and to which their response is overwhelming excitation or giving up, or both. It is proposed that this combination provokes neurovegetative responses, involving both the flight-fight and conservation-withdrawal systems, conducive to lethal cardiac events, particularly in individuals with preexisting cardiovascular disease; other modes of death, however, were also noted. Better understanding of the potentially lethal life situations and identification of individuals at risk may lead to the development of practical prophylactic measures.
ENGEL GL. Sudden and Rapid Death During Psychological Stress: Folklore or Folk Wisdom?. Ann Intern Med. 1971;74:771–783. doi: 10.7326/0003-4819-74-5-771
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Published: Ann Intern Med. 1971;74(5):771-783.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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