Mental Stress and the Induction of Silent Myocardial Ischemia in Patients with Coronary Artery Disease

Abstract

To assess the causal relation between acute mental stress and myocardial ischemia, we evaluated cardiac function in selected patients during a series of mental tasks (arithmetic, the Stroop color--word task, simulated public speaking, and reading) and compared the responses with those induced by exercise. Thirty-nine patients with coronary artery disease and 12 controls were studied by radionuclide ventriculography. Of the patients with coronary artery disease, 23 (59 percent) had wall-motion abnormalities during periods of mental stress and 14 (36 percent) had a fall in ejection fraction of more than 5 percentage points. Ischemia induced by mental stress was symptomatically "silent" in 19 of the 23 patients with wall-motion abnormalities (83 percent) and occurred at lower heart rates than exercise-induced ischemia (P less than 0.05). In contrast, we observed comparable elevations in arterial pressure during ischemia induced by mental stress and ischemia induced by exercise. A personally relevant, emotionally arousing speaking task induced more frequent and greater regional wall-motion abnormalities than did less specific cognitive tasks causing mental stress (P less than 0.05). The magnitude of cardiac dysfunction induced by the speaking task was similar to that induced by exercise. Personally relevant mental stress may be an important precipitant of myocardial ischemia--often silent--in patients with coronary artery disease. Further examination of the pathophysiologic mechanisms responsible for myocardial ischemia induced by mental stress could have important implications for the treatment of transient myocardial ischemia.

Triggering effect of physical and mental stress on spontaneous ventricular tachyarrhythmias in patients with implantable cardioverter‐defibrillators

“…Coronary ischemia may be one factor facilitating development of tachyarrhythmias that are clearly associated with myocardial infarction. Numerous studies have demonstrated potential triggering of myocardial ischemia by mental stress, [22][23][24][25][26][27] and susceptibility to transient myocardial ischemia in our patients can be expected to be high, as most of them had coronary artery disease. The hypothesis of partly ischemia-associated arrhythmic events seems to be supported by studies reporting mental stress-induced platelet activation and plasma coagulation [28][29][30] which may prove disadvantageous to coronary blood flow.…”

Hostility and anger expression behavioral and cardiovascular responses to mental stress among cardiovascular disease patients

“…In their study, they inspected the ability of ischemic responses from exercise stress testing and mental stress testing to predict silent myocardial ischemia during ambulatory monitoring. Half of the patients (23) had an ischemic response to the mental stress of giving a speech concerning personal faults (Rozanski et al, 1988), and this ischemic response to mental stress was a significant predictor of ischemia during a 48 hour period of Holter monitoring independent of response to exercise. Further, the participants with mental stress-induced ischemia had more frequent episodes of ambulatory ischemia with a longer total duration of ischemia during ambulatory monitoring.…”

“…Fichera & Andreassi, 2000;Rozanski et al, 1988). Such a task results in changes such as an increased frequency and magnitude of wall-motion abnormalities and ischemia among patients with cardiovascular disease, and in substantial changes in heart rate and blood pressure among healthy college students (Rozanski et al, 1988;Fichera & Andreassi, 2000).…”

“…While mental-stress induced ischemia can be observed reliably in the laboratory among CAD patients (e.g., Rozanski et al, 1988), it has also been observed during daily life activities using ambulatory monitoring devices and structured diaries (e.g., Gabbay et al, 1996;Gullette et al, 1997). These approaches thus help researchers observe the behaviors or specific stressful events which trigger ischemic episodes, and by extension, other cardiac events (Kop, 1999).…”

Sympathetic Vascular Tone in Human Obesity

“…Mental stress can also cause myocardial ischemia in susceptible patients and is a risk factor for hypertension and atherosclerosis [Rozanski et al, 1988;Rozanski et al, 1999;Esler et al, 2003]. Importantly, obesity is associated with a greater increase in arterial pressure in response to acute and chronic psychosocial stress [Steptoe et al, 1999;Steptoe et al, 2000].…”