Heart-brain interactions in mental stress-induced myocardial ischemia

Abstract

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.

Angina and mental stress-induced myocardial ischemia

“…Similarly, other studies have found that psychosocial characteristics of post-MI subjects, especially anxiety and depressive symptoms, are associated with higher levels of reported angina [32, 33]. It is also possible that a confluence of factors is necessary to trigger angina during everyday life, including subjective emotional distress and physiological changes in the neuroendocrine and vascular milieu, potentially leading to coronary microvascular dysfunction [34, 35]. Thus, psychosocial mechanisms underlying the propensity to develop ischemia with mental stress in the laboratory could be important contributing factors for angina symptoms in everyday life.…”

Relationship between body weight and the increment in serum brain-derived neurotrophic factor after oral glucose challenge in men with obesity and metabolic syndrome

“…It has also been reported that the anorexic effect of BDNF might correlate with the levels of several cerebral peptides such as leptin or cholecystokinin, which also have peripheral effects on cardiovascular diseases. [ 33 53 54 ] Second, all subjects with obesity underwent both diet restriction and exercise promotion. We previously reported that an increase in muscle power after aerobic exercise promotion, independent of body-weight change, could increase fasting serum BDNF [37] .…”

Meta-Analysis of Mental Stress–Induced Myocardial Ischemia and Subsequent Cardiac Events in Patients With Coronary Artery Disease

“…20 These vasomotor effects likely occur through the activation of stress-response systems; indeed, plasma catecholamines increase rapidly with mental stress and correlate with hemodynamic changes. 21 Mental stress can also induce cardiac electrical instability, as shown by an increase in T-wave alternans and other measures of abnormal cardiac repolarization that are predictors of cardiac arrhythmias and sudden cardiac death. 22–24 …”