A

Emotiol')al - Physical
Stress
.Med~llary ~~tonomic centre acti~ition

Microyc!scular spasrn
Myocardial stunning
----, I
I
I
I
I
I
I
I
I
l ______ _
Notepinephrine
.r.ele~,e
Adti?nom·edullary
1 hormQn~I
1 .stimulation v,1?o-c.oris-trictiiJn - - • iri«eased _ __ ►
~pinephrine reltaSe t '
wau sttess
I
I
t No·reptnephrine
f
____ t ►
I
Neuroho'.,mon~I actiVity,
Endoth(!lin levels
ep1n·ephrine

Phase 1 --------1 Phase. 2

Activation of the hyp_
othalamic - pituitary - adrenal axis Myocardia I dysfunction

B
II Ill IV V
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