Myocardial ischemia, which results from emotional provocation, occurs in as many as 30–50% of patients with CAD during the discourse of their daily lives. This emotionally provoked or mental stress ischemia is associated with the poor prognosis, with emerging treatment strategies. This chapter will outline the conceptual constructs which support the pathophysiologic underpinnings, and biobehavioral aspects associated with this mental stress ischemia. We will review a biobehavioral model where cognitive stress is transduced in the brain. The response of the brain to psychosocial stress is a highly sophisticated and integrated process by which sensory inputs are evaluated and appraised for its importance in relation to previous experience and current goals. The biologic consequences of such stress transduced in the CNS has its effect upon the cardiovascular flow and function through changes in autonomic balance, which result in various biologic processes that culminate in the perturbation of flow and function of the heart.

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