Pathophysiology and time course of silent myocardial ischaemia during mental stress: clinical, anatomical, and physiological correlates.

Abstract

Objective-To define the prevalence and pathophysiology of myocardial ischaemia induced by mental stress in patients with coronary artery disease and exercise inducible ischaemia, and to determine the correlation between the severity of coronary artery disease and ischaemia induced by speech. Design-Prospective cohort study. Setting-Tertiary care academic institution. Patients and protocol-47 patients with coronary artery disease and 20 normal controls were studied using standardised exercise and mental stress. The ambulatory nuclear vest provided continuous measures of left ventricular ejection fraction and relative volume changes: an ischaemic response to mental stress was defined as a decrease in ejection fraction of > 5% for > 60 s. Severity of coronary artery disease was assessed by the extent of thallium reversibility on exercise testing and the severity of angiographic disease. Results-23 (49%) of 47 patients with coronary artery disease had an ischaemic response to mental stress which occurred early, was sustained throughout the task and associated with an increase in end systolic volume. In contrast, the pattern of left ventricular response in the remaining 24 patients (51%) resembled that in the normal controls. Patients with mental stress induced ischaemia tended to have greater severity of coronary disease (mean (SD) total number of diseased vessels 1P9 (0.8) v 1-4 (0.9), P = 0.07), more frequent exercise induced angina (17/23 v 7/24, P = 0.003) and lower increases in heart rate (36 (11) v 49 (23) beats per min, P = 0*023) and systolic blood pressure (32 (19) v 45 (18) mm Hg, P = 0.03) during exercise. Left ventricular responses to speech and exercise were compared in the 23 patients with mental stress induced ischaemia: mental stress was associated with a greater decrease in ejection fraction at comparable increases in rate pressure product (-6-5 (6.3)% v 4-7 (11-2)%, P = 0.0001).Conclusions-These findings suggest that mental stress induction of myocardial ischaemia is common in patients with stable coronary artery disease. Susceptible patients may have more functionally severe coronary disease.The time course, pattern, and haemodynamic features of mental stress induced ischaemia suggest a dynamic decrease in coronary supply. (Br Heart J 1995;73:242-249)

Perceived Mental Stress and Mortality From Cardiovascular Disease Among Japanese Men and Women

“…Mental stress is a common trigger of myocardial ischemia during routine activities of daily living 6 as well as during psychological tests 21 among patients with stable coronary heart disease and/or silent exercise-induced myocardial ischemia. The development of coronary vasoconstriction has been demonstrated in areas of atherosclerotic plaques after mental stress.…”

Do Men and Women Differ on Measures of Mental Stress-Induced Ischemia?

“…Many studies examining cardiovascular responses to mental stress have used only male participants (12)(13)(14)(15)(16). Previous studies which included both genders still had few women.…”

Cholinergic stimulation with pyridostigmine blunts the cardiac responses to mental stress

“…Although these effects are part of a normal physiological response, mental stress or emotion may also produce myocardial ischemia [5][6][7], decreased left ventricular ejection fraction [7], and ventricular arrhythmia in patients with coronary artery disease [6,[8][9][10].…”