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Mental versus physical stress, QT prolongation, and the autonomic nervous system.

A 56-year-old male physician with essential hypertension, elevated blood cholesterol, and irritable bowel syndrome underwent exercise radionuclide perfusion imaging and 24-hour Holter monitor because of palpitations at rest. The exercise perfusion test was within normal limits. During the Holter monitoring period, the subject was taking enalapril, simvastatin, and clonipine. The Holter study demonstrated no clinically significant arrhythmias. During the monitoring, the patient was awakened from sleep at 4:40 am and told that his brother-in-law had suddenly died. The Holter ECG tracing at that time is shown in the Figure⇓, panel A, demonstrating a sinus tachycardia heart rate …