Effect of Iraqi missile war on incidence of acute myocardial infarction and sudden death in Israeli civilians

The Iraqi missile attack on Israel provided a unique opportunity to study the effects of fright due to a perceived threat of annihilation on the incidence of acute myocardial infarction (Ml) and sudden death among the civilian population. During the first days of the Gulf war we noted a sharp rise in the incidence of acute Ml and sudden death in our area compared with five control periods. Patient population in the various study periods did not differ significantly in age, sex ratio, hospital mortality, or proportion of patients in whom the acute event was the first presentation of coronary disease. However, during the first period of the war there were more cases of anterior wall MI and more patients received thrombolytic therapy than during control periods. Despite the continuing missile threat, the incidence of acute Ml reverted to normal after the initial phase of the Gulf war.