Mental stress-induced myocardial ischemia is associated with a significant increase in systemic vascular resistance and a relatively minor increase in heart rate and rate-pressure product compared with ischemia induced by exercise. These hemodynamic responses to mental stress can be mediated by the adrenal secretion of epinephrine. The pathophysiological mechanism involved are important in the understanding of the etiology of myocardial ischemia and perhaps in the selection of appropriate anti-ischemic therapy.

Background-Ischemia during laboratory mental stress tests has been linked to significantly higher rates of adverse cardiac events. Previous studies have not been designed to detect differences in mortality rates. Methods and Results-To determine whether mental stress-induced ischemia predicts death, we evaluated 196 patients from the Psychophysiological Investigations of Myocardial Ischemia (PIMI) study who had documented coronary artery disease and exercise-induced ischemia. Participants underwent bicycle exercise and psychological stress testing with radionuclide imaging. Cardiac function data and psychological test results were collected. Vital status was ascertained by telephone and by querying Social Security records 3.5Ϯ0.4 years and 5.2Ϯ0.4 years later. Of the 17 participants who had died, new or worsened wall motion abnormalities during the speech test were present in 40% compared with 19% of survivors (Pϭ0.04) and significantly predicted death (rate ratioϭ3.0; 95% CI, 1.04 to 8.36; Pϭ0.04). Ejection fraction changes during the speech test were similar in patients who died and in survivors (Pϭ0.9) and did not predict death even after adjusting for resting ejection fraction (Pϭ0.63), which was similar in both groups (mean, 56.4 versus 59.7; Pϭ0.24). Other indicators of ischemia during the speech test (ST-segment depression, chest pain) did not predict death, nor did psychological traits, hemodynamic responses to the speech test, or markers of the presence and severity of ischemia during daily life and exercise. Conclusions-In patients with coronary artery disease and exercise-induced ischemia, the presence of mental stressinduced ischemia predicts subsequent death.

Background. Prior studies have had difficulty identifying factors that significantly explain patients' delay in responding to symptoms of acute myocardial infarction (AMI).Methods and Results. We therefore examined factors affecting the time between symptom onset and hospital arrival for 103 AMI patients admitted to a Detroit metropolitan hospital between October 1989 and January 1990. Variables evaluated included demographic and medical history factors, psychological characteristics of somatic and emotional awareness, and type A behavior. The mean prehospital delay time was 9.0±10.8 hours (median, 5.0 hours; range, 0.25-62.0 hours). Delay time was not significantly associated with demographic or medical history categories or with type A behavior. Of study variables that can be identified prior to evolution of an AMI, somatic and emotional awareness were the only factors significantly predictive of delay time. Patients who were more capable of identifying inner experiences of emotions and/or bodily sensations sought treatment significantly earlier than patients with low emotional or somatic awareness (low emotional awareness median delay, 12.8 hours; high emotional awareness median delay, 3.8 hours; low somatic awareness median delay, 7 hours; high somatic awareness median delay, 4 hours).Conclusions. Variations in sensitivity to bodily sensations and emotions appear to play an important role in treatment seeking and thus potentially in treatment outcome for AMI patients. Assessment of these characteristics in patients with coronary risk factors could allow early identification of persons at risk of excessive delay in responding to symptoms of AMI. (Circulation 1991;84:1969-1976 In order to have an objective indicator of the size of infarction, the peak level of total CK was recorded for each patient. A subjective rating of the patient's perceived severity of symptoms (intensity, duration, and range of symptoms experienced) was also recorded using a scale derived from Matthews and colleagues.13 Study Variables and InstrumentsThe primary dependent variables of the study included 1) delay time between onset of symptoms and illness decision; 2) delay time between illness decision and hospital arrival; and 3) total delay between symptom awareness and hospital arrival. Symptom onset was considered the onset of any acute symptoms identified by the patient, including chest pain or discomfort, dyspnea, diaphoresis, nausea/vomiting/epigastric discomfort, and arm, neck, or back pain.The psychological variable of somatic awareness was assessed using the Modified Somatic Perception Questionnaire (MSPQ),18 which provides an index of general bodily awareness by asking patients to rate their experience of noncardiac somatic and autonomic symptoms over a specified time period. Examples of items include frequency of feeling hot all over, blurring of vision, churning stomach, and dry mouth.The MSPQ has been used in at least one other study of cardiac symptomatology'6 because of its lack of direct cardiac-related symptoms. Due to ...

Dyadic exchanges of support and control were investigated in couples in which the husband was recently treated or assessed for heart disease. Each partner in 61 marital dyads (N = 122 participants) reported the frequency with which both social support and social control to promote a healthy lifestyle were provided to and received from one another. Multivariate findings demonstrated the influence of intrapersonal (or actor) and interpersonal (or partner) contributions of providing support and control to each spouse's perception of receiving such exchanges from the other. These findings reveal that marital partners' perspectives of receipt of health-related exchanges of support and control are associated not only with the behavior of the partner, but also with their own initiation of health-promoting exchanges on their partner's behalf. KEY WORDS: dyadic analysis • marriage and health • social control • social support Although social exchanges necessarily involve at least two partners, one to provide and the other to receive, relatively few studies involve both

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Use of a significant other in assessing psychosocial/emotional distress in males may confer greater accuracy, and therefore predictive power for clinical endpoints.

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Study design, quality control data, and baseline characteristics of patients enrolled for a clinical study of symptomatic and asymptomatic myocardial ischemia are described. Lower repeatability of reading wall motion abnormalities during mental stress than during exercise may be due to smaller effects on wall motion and lack of an indicator for peak mental stress.