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Nicotine stimulates the adrenal medulla to release adrenaline, and directly stimulates the sympathetic nervous system, resulting in increased heart rate, blood pressure, peripheral vascular resistance and myocardial contractility

Ironically, smoking actually increases stress, but its one way many folks attempt to alleviate it

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These cases highlight the unique clinical presentation and multiple manifestations of this disease and show how a multidisciplinary management approach kept symptoms under control and significantly improved patient quality of life