Effects of Psychologic Stress on Repolarization and Relationship to Autonomic and Hemodynamic Factors

Lampert, Rachel; Shusterman, Vladimir; Burg, Matthew M.; Lee, Forrester A.; Earley, Christine; Goldberg, B; McPherson, Craig A.; Batsford, William P.; Soufer, Robert

doi:10.1046/j.1540-8167.2005.40580.x

Cited by 86 publications

(87 citation statements)

References 47 publications

(127 reference statements)

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“…Mental stress can induce proarrhythmic electrocardiological changes and compromise ventricular function in vulnerable patients (2,5,6,26). The brain correlates of this effect, mediated through stress-induced autonomic drive to the heart (increased sympathetic tone and decreased parasympathetic tone), was examined in a positron emission tomography (PET) study of cardiovascular patients.…”

mentioning

confidence: 99%

A cortical potential reflecting cardiac function

Gray

Taggart

Sutton

et al. 2007

Proc. Natl. Acad. Sci. U.S.A.

179

125

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Emotional trauma and psychological stress can precipitate cardiac arrhythmia and sudden death through arrhythmogenic effects of efferent sympathetic drive. Patients with preexisting heart disease are particularly at risk. Moreover, generation of proarrhythmic activity patterns within cerebral autonomic centers may be amplified by afferent feedback from a dysfunctional myocardium. An electrocortical potential reflecting afferent cardiac information has been described, reflecting individual differences in interoceptive sensitivity (awareness of one's own heartbeats). To inform our understanding of mechanisms underlying arrhythmogenesis, we extended this approach, identifying electrocortical potentials corresponding to the cortical expression of afferent information about the integrity of myocardial function during stress. We measured changes in cardiac response simultaneously with electroencephalography in patients with established ventricular dysfunction. Experimentally induced mental stress enhanced cardiovascular indices of sympathetic activity (systolic blood pressure, heart rate, ventricular ejection fraction, and skin conductance) across all patients. However, the functional response of the myocardium varied; some patients increased, whereas others decreased, cardiac output during stress. Across patients, heartbeat-evoked potential amplitude at left temporal and lateral frontal electrode locations correlated with stress-induced changes in cardiac output, consistent with an afferent cortical representation of myocardial function during stress. Moreover, the amplitude of the heartbeat-evoked potential in the left temporal region reflected the proarrhythmic status of the heart (inhomogeneity of left ventricular repolarization). These observations delineate a cortical representation of cardiac function predictive of proarrhythmic abnormalities in cardiac repolarization. Our findings highlight the dynamic interaction of heart and brain in stress-induced cardiovascular morbidity. afferent homeostatic feedback ͉ electroencephalography ͉ heart beat-evoked potential ͉ insula cortex ͉ ischemia

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mentioning

confidence: 99%

A cortical potential reflecting cardiac function

Gray

Taggart

Sutton

et al. 2007

Proc. Natl. Acad. Sci. U.S.A.

179

125

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“…This may lead to an increased demand for oxygen by the heart and myocardial ischemia (Ramachandruni et al, 2006). Sympathetic activation may also decrease the threshold for arrhythmic vulnerability (Lampert et al, 2002;Lampert et al, 2005). These relationships may be more pronounced in patients with known CHD.…”

Section: Catecholamines and Chdmentioning

confidence: 99%

“…Ramachndruni et al (2006) found that laboratory mental stress induced ischemia (defects of perfusion) in CHD patients. Laboratory mental-stress has also been demonstrated to increase the levels of arrhythmic vulnerability in ICD patients (Lampert et al, 2000;Lampert et al, 2005).…”

Section: Catecholamines and Chdmentioning

confidence: 99%

“…Furthermore, research indicates that people, especially CHD patients, who have sympatho-vagal imbalance in the regulation of the heart, are at a higher risk for aversive cardiac events (MI, lethal arrhythmias) (Lucini et al, 2002;Stein & Reddy, 2005). This pathophysiolgical relationship is especially pronounced during mental stress (Lampert et al, 2005;Rozanski et al, 2005). The analyses of the autonomic control of the heart by using a range of markers (HRV, catecholamine level, and BP) may help to get better information about the state of sympatho-vagal balance of the heart.…”

Section: Mental Stress and Hrvmentioning

confidence: 99%

“…The correlation coefficients were higher for men with high BP, but they were also significant for men with normal BP. Lampert et al (2005) studied changes in BP, catecholamine level, HF, HR and Twave alternans (TWA) from rest to mental stress (anger recall and mental arithmetic) in 33 ICD patients. In the 33 patients, significant changes from rest to stress in catecholamine level, BP, HF, TWA and HR (p = .01 -.001) were observed (Lampert et al, 2005).…”

Section: Mental Stress and Hrvmentioning

confidence: 99%

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Heart Rate Variability, Catecholamine and Hemodynamic Responses During Rest and Stress in Coronary Artery Disease Patients: The PIMI Study

Ghambaryan¹

2007

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Altered cardiac autonomic balance has been shown to be a predictor of adverse cardiac events in patients with cardiovascular decease (CAD). Alteration of the sympatho-vagal balance of heart regulation may be more evident during periods of mental stress. The high frequency (HF) component of heart rate variability (HRV) is a marker of the parasympathetic regulation of the heart. The meaning of the low frequency (LF) component of HRV is controversial, but it may represent the sympathetic modulation of heart regulation. Plasma catecholamine levels (epinephrine and norepinephrine) are markers of sympathetic nervous system action. Increases in hemodynamic (blood pressure and heart rate) responses to stress are predominantly regulated by the sympathetic branch of the autonomic nervous system (ANS). The relationships among the frequency domains of HRV, hemodynamics, and catecholamine level were examined at rest and during speech mental stress in 147 CAD patients from the Psychophysiological Investigations of Myocardial Ischemia (PIMI) study. At rest, there were no significant associations between HRV measures, hemodynamic responses, and plasma catecholamine levels. However, at peak stress levels, analyses of variance revealed a significant inverse relation between HF levels and epinephrine (Epi), (univariate F (3, 132) = 2.9; p= .037); and a significant inverse relation between LF and catecholamine levels, (multivariate F (6, 258) = 3.7; p =.001). At peak stress levels, HF levels were inversely related to systolic blood pressure (SBP) and heart rate (HR) (F SBP (3, 141) = 3.9; p =0.01; and F HR (3, 141) = 7.2; p < 0.001). At peak stress levels LF was inversely related to SBP and HR, (F SBP (3, 140) = 8.9; p < 0.001; and F HR (3, 140) = 4.0; p = 0.009). These findings suggest that associations of the vagal components (HF) of HRV with sympathetic markers in CAD patients are only revealed under conditions of mental stress. In addition, based on the data,

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The Insular Cortex and the Regulation of Cardiac Function

Oppenheimer

Cechetto

2016

Comprehensive Physiology

156

124

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Cortical representation of the heart challenges the orthodox view that cardiac regulation is confined to stereotyped, preprogrammed and rigid responses to exteroceptive or interoceptive environmental stimuli. The insula has been the region most studied in this regard; the results of clinical, experimental, and functional radiological studies show a complex interweave of activity with patterns dynamically varying regarding lateralization and antero-posterior distribution of responsive insular regions. Either acting alone or together with other cortical areas including the anterior cingulate, medial prefrontal, and orbito-frontal cortices as part of a concerted network, the insula can imbue perceptions with autonomic color providing emotional salience, and aiding in learning and behavioral decision choice. In these functions, cardiovascular input and the right anterior insula appear to play an important, if not pivotal role. At a more basic level, the insula gauges cardiovascular responses to exteroceptive and interoceptive stimuli, taking into account memory, cognitive, and reflexive constructs thereby ensuring appropriate survival responses and maintaining emotional and physiological homeostasis. When acquired derangements to the insula occur after stroke, during a seizure or from abnormal central processing of interoceptive or exteroceptive environmental cues as in psychiatric disorders, serious consequences can arise including cardiac electrophysiological, structural and contractile dysfunction and sudden cardiac death.

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Effects of Psychologic Stress on Repolarization and Relationship to Autonomic and Hemodynamic Factors

Abstract: Psychological stress increased TWA, Tamp, and Tarea. Autonomically mediated repolarization changes may be a pathophysiologic link between emotion and arrhythmia in susceptible patients.

Cited by 86 publications

References 47 publications

A cortical potential reflecting cardiac function

A cortical potential reflecting cardiac function

Heart Rate Variability, Catecholamine and Hemodynamic Responses During Rest and Stress in Coronary Artery Disease Patients: The PIMI Study

The Insular Cortex and the Regulation of Cardiac Function

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