Donald Edmondson

The Association of Emergency Department Crowding During Treatment for Acute Coronary Syndrome With Subsequent Posttraumatic Stress Disorder Symptoms

ed clinical data from medical charts. We assessed inhospital depression symptoms with the Beck Depression Inventory (BDI), and ACS-induced PTSD symptoms by telephone interview 1 month later using the Impact of Events Scale-Revised (IES-R)6 -specific for ACS. We tested for group differences across ED crowding tertiles using one-way analysis of variance for continuous variables and chi-square for categorical variables. We used multiple linear regression to assess the association of ED crowding to PTSD symptoms at 1 month.

The 'perfect storm' and acute coronary syndrome onset: do psychosocial factors play a role?

The revolution in cardiac care over the past two decades, characterized by emergent revascularization, drug eluting stents, anti-platelet medications, and advanced imaging has had little impact on overall ACS recurrence, or ACS prevention. The Perfect Storm refers to a confluence of events and processes, including atherosclerotic plaque, coronary flow dynamics, hemostatic and fibrinolytic function, metabolic and inflammatory conditions, neurohormonal dysregulation, and environmental events that give rise to, and result in an ACS event. In this article we illustrate the limits of the traditional main effect research model, giving a brief description of the current state of knowledge regarding the development of atherosclerotic plaque and the rupturing of these plaques that defines an ACS event. We then apply the Perfect Storm conceptualization to describe a program of research concerning a psychosocial vulnerability factor that contributes to increased risk of recurrent ACS and early mortality, and that has defied our efforts to identify underlying pathophysiology and successfully mount efforts to fully mitigate this risk.