Possible mechanisms that link air pollution with increased cardiovascular morbidity and mortality. Air pollutants may trigger pulmonary reflexes that can activate the autonomic nervous system and result in alterations of heart rate variability and induction of dysrhythmias (in green). Air pollutants may directly affect cardiac tissue leading to the induction of dysrhythmias and/or cardiomyopathy (in yellow). Air pollutants can also enhance atherothrombotic processes that lead to the development of acute coronary syndromes (ACS) via the generation of pulmonary inflammation or direct translocation into the systemic circulation (in blue). Atherothrombotic processes include increased vascular oxidative stress, endothelial cell dysfunction, atherosclerosis and increased platelet aggregability and coagulation, among others.