Impact of gravitational interaction between the Moon and the Earth on the occurrence of episodes of cardiogenic pulmonary edema in the field

While circadian variation of occurrence of cardiovascular emergencies has been de-scribed, it has not been assessed whether fluctuations of gravitational interaction between the Earth and the Moon may in-duce other types of its variation in time have the similar impact. Therefore, we decided to evaluate whether there is an as-sociation between the occurrence of pre-hospital cardiogenic pulmonary edema (CPE) episodes treated by Emergency Medical Services (EMS) and fluctuations in the intensity of gravitational interaction between the Earth and the Moon. Methods. We extracted all dispatches to CPE episodes from the EMS database of the Central Bohemian Region, Czech Re-public, between 2.11.2008 and 1.7.2014. For each episode, the intensity of gravita-tional interaction between the Moon and the Earth was calculated. The study period was divided into 11 sections of equal dura-tion according to the different intensity of gravitational interaction, and occurrence of CPE was compared among the groups. Results. We observed up to 4,744 episodes of CPE during the study period. Occur-rence of CPE episodes was highest in the periods with the weakest intensity of gravitational interaction (≤1.80e1026 N), while in the periods of the most intense gravitational interaction (≥2.26e1026 N), the lowest proportion of CPE cases was observed (23.44 vs. 3.79 %, p <0.001). Conclusions. We identified a significant association between the intensity of gravi-tational interaction between the Earth and the Moon and occurrence of CPE, treated by our EMS. The weakest intensity was as-sociated with its increased occurrence and vice versa. Further research is required for potential use of this phenomenon in a chronotherapeutic approach to secondary prevention of CPE.

cardiogenic pulmonary edema, gravitational interaction

1. Kanth R. Impact of lunar phase on the incidence of cardiac events. World J Cardiovasc Dis 2012;02:124–8.

2. Wende R, von Klot S, Kirchberger I, Kuch B, von Scheidt W, Peters A, et al. The influence of lunar phases on the occurrence of myo-cardial infarction: fact or myth? The MONICA/KORA Myocardial Infarction Registry. Eur J Prev Cardiol 2013;20:268-74.

3. Shuhaiber JH, Fava JL, Shin T, Dobrilovic N, Ehsan A, Bert A, et al. The influence of seasons and lunar cycle on hospital outcomes following ascending aortic dissection repair. Interact Cardiovasc Thorac Surg 2013;17:818–22.

4. Kuehnl A, Herzog M, Schmidt M, Hornung H-M, Jauch K-W, Hatz RA, et al. The dark side of the moon: impact of moon phases on long-term survival, mortality and morbidity of surgery for lung cancer. Eur J Med Res 2009;14:178–81.

5. Snoyman P, Holdstock TL. The influence of the sun, moon, climate and economic conditions on crisis incidence. J Clin Psychol 1980;36:884–93.

6. Pokorny AD. Moon phases and mental hospital admissions. J Psychiatr Nurs Ment Health Serv 1968;6:325-7.

7. Rovensky J, Mikulecky M. Pseudogout: Timing of attacks and the cosmogeophysical environment. Clin Exp Rheumatol 2000;18:507–9.

8. Wake R, Misugi T, Shimada K, Yoshiyama M. The effect of the gravitation of the moon on frequency of births. Environ Health In-sights 2010;4:65–9.

9. Alves DW, Allegra JR, Cochrane DG, Cable G. Effect of lunar cycle on temporal variation in cardiopulmonary arrest in seven emer-gency departments during 11 years. Eur J Emerg Med 2003;10:225–8.

10. Eisenburger P, Schreiber W, Vergeiner G, Sterz F, Holzer M, Herkner H, et al. Lunar phases are not related to the occurrence of acute myocardial infarction and sudden cardiac death. Resuscitation 2003;56:187–9.

11. Nadeem R, Nadeem a, Madbouly E, Molnar J, Morrison J. Effect of a full moon on mortality of patients admitted to the ICU. Crit Care 2012;16:P499.

12. Wake R, Yoshikawa J, Haze K, Otani S, Yoshimura T, Toda I, et al. The gravitation of the moon plays pivotal roles in the occurrence of the acute myocardial infarction. Environ Health Insights 2008;1:63–6.

13. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013;34:2159–219.

14. Bass J. Circadian topology of metabolism. Nature 2012;491:348–56.

15. Sivaprasad, S. Circadian Biorhythms – Present Understanding and Status of Research. Indian J Appl Res 2014;IV:729–32.

16. Buff DD, Calikyan R, Neches RB, Bavli SZ. Circadian patterns in the onset of cardiogenic acute pulmonary edema. Clin Cardiol 1997;20:261–4.

17. Cohen MC, Rohtla KM, Lavery CE, Muller JE, Mittleman M a. Meta-analysis of the morning excess of acute myocardial infarction and sudden cardiac death. Am J Cardiol 1997;79:1512–6.

18. Elliott WJ. Circadian variation in the timing of stroke onset: a meta-analysis. Stroke 1998;29:992–6.

19. Hakim H, Samadikhah J, Alizadehasl A, Azarfarin R. Chronobiological rhythms in onset of massive pulmonary embolism in Iranian population. Middle East J Anaesthesiol 2009;20:369–75.

20. Vitale J, Manfredini R, Gallerani M, Mumoli N, Eagle KA, Ageno W, et al. Chronobiology of acute aortic rupture or dissection: a systematic review and a meta-analysis of the literature. Chronobiol Int 2015;32:385–94.

21. Mcgraw-Hill. Encyclopedia of Science and Technology. 7th ed. McGraw-Hill; 1992.

22. Mallion J-M, Neuder Y, Ormezzano O, Rochette GB, Salvat M, Baguet JP. Study of nycthemeral variations in blood pressure in pa-tients with heart failure. Blood Press Monit 2008;13:163–5.

23. Shin J, Kline S, Moore M, Gong Y, Bhanderi V, Schmalfuss CM, et al. Association of diurnal blood pressure pattern with risk of hos-pitalization or death in men with heart failure. J Card Fail 2007;13:656–62.