Ayman Hammoudeh, Md, Facc2, Eyadeh Mdanat, Md1, Hadi Abu-Hantash1, Ramzi Tabbalat3, Eyas Al-Mousa2, Raad Al-Muhaisen3, Mahmoud Fakhri4, Imad A Alhaddad4

1Farah Medical Center, Amman, Jordan, 2Istishari Hospital, Amman, Jordan, 3Abdali Hospital, Amman, Jordan, 4Jordan Hospital, Amman, Jordan

Background:
Psychosocial stresses related to human-made or natural disasters are associated with an excess surge in the incidence of acute cardiovascular events (CVE). The stresses related to the Covid-19 lockdown imposed on a global scale have been reported to cause behavioral and mental changes, but not acute CVE. We studied the impact of the lockdown stressors on triggering acute events among non-infected individuals in Amman, Jordan.

Method(s):
Adult patients evaluated for acute CVE in 10 hospitals in Amman during the Covid-19 lockdown from March 15 through August 1 were enquired about exposure to a triggering event prior to sustaining the acute myocardial infarction (AMI), stroke, or sudden cardiac death (SCD).

Result(s):
We identified 115 patients who fulfilled the inclusion criteria including 102 (89%) with AMI, 7 (6%) with stroke and 6 (5%) with SCD. The mean age of the cohort was 61.6+13.1 years and 25 (22%) were women. Hypertension, diabetes and cigarette smoking were present in 68 (59%), 46 (40%) and 62 (54%), respectively. Of the whole cohort, 44 (38%) had a prior diagnosis of CVD and 35 (30%) had past coronary revascularization. Coronary revascularization was done for 79 (77%) of AMI patients. The most common triggering events related to the lockdown were: lockdown stress, loneliness and isolation: 91 (79%), financial stress: 43 (37%), binge smoking: 26 (23%). and anger: 23 (20%).

A lot of other stressors were also noted and documented, such as: increased physical activity, disrupted sleep, death of a significant person, heavy meals and binge eating, hopelessness, fear to get or spread infection, fear of lack of medical care, anxiety, kids have virtual exams stress, fear of death, acute depression, and stress from taking care of handicap son/daughter during quarantine.

In hospital mortality for patients with AMI and stroke was 0.9%

Conclusion(s):
In this era of covid-19 pandemic, we report for the first time the occurrence of lockdown-related intense psychosocial stressors that triggered acute cardiovascular events in non-infected individuals. Screening for early symptoms and early intervention in susceptible population is warranted to avoid these triggered events.