With the continuous development of today’s society and the increasing pace of work and life, the physical and mental pressure on young people, who are the main productive group in society, is increasing day by day. Long-term physical fatigue and excessive mental load, as well as the consequent depression, irritability and other adverse psychological emotions together constitute a common state of adverse stress suffered by young people. The sudden death of young people due to chronic fatigue stress is a common occurrence, especially in first-tier cities such as North, Guangzhou and Shenzhen, and the early death of these lives not only brings great disaster to their families, but also has a serious negative impact on social production and generates a huge medical and social burden. Epidemiology of sudden cardiac death in young people Surveys show that about 80% of white-collar workers in China are overworked, and among those who die young between the ages of 30 and 50, 95.7% die from fatal diseases caused by overwork, 80% of which are sudden cardiac deaths. Sudden cardiac death (SCD) refers to sudden death from cardiovascular causes, with or without structural heart disease. SCD is generally considered to be death within 1 h of sudden onset or within 24 h of the last known stable state. The most common causes are acute coronary syndrome, dilated cardiomyopathy, genetically related rhythm disturbances (e.g., long QT syndrome, Brugada syndrome, and catecholamine-associated polymorphic ventricular tachycardia), and various types of cardiomyopathies (e.g., stress cardiomyopathy). According to statistics, the total number of sudden cardiac death in the United States is 300,000 per year, with an annual incidence of 0.1% to 0.2%, and the incidence in Europe is similar to that in the U.S. The epidemiological survey of sudden death in the Chinese population shows that the incidence of sudden death in China is 41.84 cases/100,000 people per year, with an incidence of about 0.04% of the general population, which is lower than that in Europe and the United States, but with a further projection of the country’s 1.3 billion population, China annually However, with a population of 1.3 billion, China has nearly 544,000 sudden deaths each year, with an average of about 1,500 people per day. The success rate of out-of-hospital resuscitation of sudden death in China is less than 1% due to the level of pre-hospital assistance and emergency transport system in China. Therefore, it is of great significance to study the relationship between the adverse stress caused by long-term fatigue and sudden death in young people, to clarify the mechanism of sudden death in young people, and to take effective preventive measures for individuals, families and society. The role of stress in bridging sudden cardiac death Stress refers to the physical and psychological tension and its reactions caused by the imbalance between the actual or cognitive demands and the ability to adapt and cope in the process of adapting to various adverse factors in the survival environment. With the progress of modern medicine, it has become increasingly clear to mankind that the regression of health and life depends on the biological effects of the interaction between the environment and the organism, and that environmental factors are one of the important factors in the occurrence of disease. According to statistics, about 70% to 90% of the risk of disease can be attributed to the effects of environmental exposure, and stress is an important interface of the interaction between the environment and the organism. Sudden death as the most serious result of stress diseases, especially stress-induced sudden death in young people, is a hot spot for stress disease research at home and abroad in recent years. Stress-induced sudden death is not only limited to humans, but also has similar problems in animals, which often die rapidly when animals cannot escape, are subjected to bundles of being placed in places where excessive and strong stimuli can be expected, and after the death of their mates. It has been reported that when an American camel was shot, its mate died within minutes. Sudden cardiac death is often preceded by arrhythmias that lead to cardiac arrest. The mechanism of sudden cardiac death due to stress, Lown proposed four associated hypotheses namely: the immediate cause of sudden death is ventricular fibrillation; electrical instability exists long before sudden death; an indicator of electrical instability is some type of ventricular pre-term contraction; and stress can cause the onset of electrical instability and increase susceptibility to ventricular fibrillation. In addition, chronic fatigue stress causes strong long-term stimulation of sympathetic nerves, which can lower the stimulation threshold of preterm contraction in experimental animals, as well as the threshold of electrical stimulation that causes ventricular fibrillation; therefore, sympathetic nerves also play an important role in sudden cardiac death. Chronic fatigue stress and coronary heart disease in young people Coronary heart disease accounts for 65% to 80% of sudden cardiac deaths, and as the most important cause of sudden cardiac death, long-term chronic fatigue stress triggering sudden cardiac death in young people with coronary heart disease is a common occurrence. Chronic fatigue stress is not only the cause of early onset of coronary heart disease in young people, but also the cause of sudden cardiac death in young patients with coronary heart disease. According to numerous studies, the occurrence and development of coronary heart disease are related to many biological, psychological and social factors, including genetics, hypertension, hyperlipidemia, smoking, alcoholism, obesity, type A behavior type, incompatible social relationships and anxiety and depression. Disorders of lipid metabolism, hemodynamic changes and changes in the arterial wall itself are direct factors in the development of coronary heart disease. Psychological and social factors can influence the occurrence and development of coronary heart disease by affecting the above 3 processes through neuroendocrine mediating mechanisms. Studies have shown that chronic fatigue stress, such as long working hours, overload, and more than two different jobs, may increase the incidence of coronary heart disease and death rate. Young patients with coronary artery disease are in a chronic fatigue state for a long time, which makes the accumulation of inflammatory factors and leukocytes destroy the vascular endothelial structure of coronary arteries, prompting the release of interleukins and tumor necrosis factor and other inflammatory cells in the body to degrade the extracellular matrix of coronary atheromatous plaques and reduce the stability of plaques, leading to coronary reobstruction triggering acute myocardial infarction; in addition, large coronary arteries are rich in α In addition, the large coronary arteries are rich in the distribution of α-adrenergic receptors, and chronic fatigue stress continues to activate the nucleus accumbens, which is rich in noradrenergic neurons, and sympathetic tone continues to be hyperactive and catecholamine secretion increases, which excites α-receptors in the coronary arteries, causing coronary spasm and prompting the reoccurrence of myocardial infarction in young patients with coronary heart disease and increasing the risk of sudden cardiac death. Chronic fatigue stress and stress cardiomyopathy in young adults Stress cardiomyopathy, also known as Takotsubo cardiomyopathy, is a cardiac disorder associated with mental or physical stress, with temporary abnormalities in left ventricular (and possibly right ventricular) wall motion as the main manifestation. A meta-study found that about 1% to 2% of patients admitted with a proposed diagnosis of acute coronary syndrome, heart failure, or arrhythmia had stress cardiomyopathy, which is often misdiagnosed and underdiagnosed because of the current lack of awareness of the disease among clinicians, and stress cardiomyopathy is one of the main causes of sudden cardiac death. Somatic stress and mental stress are considered to be the main causes of stress cardiomyopathy. With the increasing pressure of work life in modern society, young people, as the main force of social productivity, are in a chronic fatigue stress state of physical fatigue and mental depression for a long time, leading to an increasing incidence of stress cardiomyopathy, which has gradually attracted the attention of experts and scholars as one of the causes of sudden cardiac death. In a systematic evaluation of stress cardiomyopathy in young people, Wang et al. found that physical stress was the main precipitating factor in young patients with stress cardiomyopathy; the incidence was higher in young women than in young men, probably because women’s hearts are more sensitive to sympathetic nerves and more prone to cardiac contraction disorders, and women have a lower threshold of response to stress than men with more fragile and sensitive traits. The mechanism of chronic fatigue stress in the pathophysiology of stress cardiomyopathy in young people is still unclear, but the possible pathogenesis is that long-term chronic fatigue stress may cause structural changes in the brain, a decrease in the body’s sensitivity to the hypothalamic-pituitary-adrenocortical axis, and an increase in the secretion of adrenocorticotropic hormones and glucocorticoids At the same time, adrenocorticotropic hormone enhances the release of adrenomedullary epinephrine and norepinephrine, leading to a high level of catecholamines in the body for a long time, and the toxic effects of supraphysiological amounts of catecholamines on the heart contribute to the occurrence of stress cardiomyopathy in young people. The pathogenesis of chronic fatigue stress-induced arrhythmias When the body is under long-term fatigue stress, the mitochondria produce excessive production of highly reactive molecules such as reactive oxygen species (ROS), and the degree of oxidation exceeds the scavenging capacity of oxidants, leading to a series of myocardial ion channel changes that cause the occurrence of ventricular arrhythmias. ROS has been shown to affect Na ion channel function through multiple pathways. At the transcriptional level, ROS reduces Nav1.5 sodium channel gene expression by decreasing mRNA expression; at the protein level, ROS directly inactivates methionine oxidation in the Nav1.5 sodium channel protein, leading to a decrease in peak Na ion channel current, and ROS also increases the probability of Na ion channel opening, which This leads to late sodium current increase causing changes in cardiac rhythm including action potential, prolongation of early post-depolarization, and calcium overload. ROS can also affect sodium channel phosphorylation by indirectly altering the membrane lipid environment or by activating signal transduction molecules such as protein kinase C and calmodulin-dependent protein kinase II to reduce peak sodium currents, leading to arrhythmias. Activation of calmodulin-dependent protein kinase II also phosphorylates subunits of Cav1.2 calcium channels, opening L-type calcium channels and increasing calcium inward flow as well as cardiomyocyte responsiveness to isoproterenol, leading to delayed post-depolarization and impaired cardiac contraction. In addition, excess intracellular ROS decreases current repolarization of potassium ions, prolongs the duration of action potential, early postdepolarization time, and increases the electrical heterogeneity of cardiomyocytes and susceptibility to arrhythmias. Finally, ROS-induced mitochondrial dysfunction can also cause depolarization of the mitochondrial membrane potential, leading to the opening of sarcKATP channels, which in turn creates a perfusion current that propagates depolarization waves, increasing the potential for conduction block and arrhythmias. In summary, chronic fatigue stress may contribute to sudden cardiac death by increasing ROS production and causing ventricular arrhythmias through changes in myocardial ion channels. Chronic fatigue has become a prevalent “modern disease” in the fast-developing modern society, and is an important cause of sudden cardiac death in young people under high stress. It is urgent to study the relationship between chronic fatigue stress and sudden cardiac death in young people, to explore the early warning mechanism of sudden cardiac death caused by chronic fatigue stress, to screen the groups at risk of sudden death in young people under chronic fatigue stress, to take early preventive measures, to provide an insurance for young people who are the backbone of society, and to make some contribution to the health of the main building blocks of families and society.