Prevalência de isquemia induzida por estresse mental

Abstract

Background: The myocardial radionuclide imaging with mental distress seems to induce ischemia through a particular physiopathology when compared to radionuclide imaging with physical or pharmacological distress.Objective: To assess the prevalence of induced myocardial ischemia by mental distress in patients with thoracic pain and radionuclide imaging with normal conventional distress, with 99mTc-Sestamibi.Methods: Twenty-two patients were admitted with thoracic pain at emergency or were referred to the nuclear medicine service of our institution, where myocardial radionuclide imaging of distress or rest without ischemic alterations was carried out. The patients were, then, invited to go through an additional phase with mental distress induced by color conflict (Strop Color Test) with the objective of detecting myocardial ischemia. Two cardiologists and nuclear physicians performed the blind analysis of perfusional data and consequent quantification through Summed Difference Score (SDS), punctuating the segments that were altered after mental distress and comparing it to the rest period image. The presence of myocardial ischemia was considered if SDS ≥ 3.Results: The prevalence of mental distress-induced myocardial ischemia was 40% (9 positive patients). Among the 22 studied patients, there were no statistical differences with regard to the number of risk factors, mental distress-induced hemodynamic alterations, usage of medications, presented symptoms, presence or absence of coronary disease and variations of ejection fraction and final systolic volume of Gated SPECT. Researches that used echocardiogram and radioisotope ventriculography associated with mental distress showed that this is the responsible for alterations in ventricular function 5,6 . Studies that applied radionuclide imaging of myocardial perfusion during mental distress confirmed that the contraction alterations were induced by alterations in perfusion. Conclusion Prevalence of Induced Ischemia by Mental DistressThe necessity for myocardial ischemia diagnosis in patients with thoracic pain is extremely important for a better clinical handling, risk factor control and improvement of their life quality. In this decade, an acute syndrome, unleashed by mental distress and represented by thoracic pain, supraunevenness of ST segment at electrocardiogram, elevation of myocardial necrosis markers and peculiar alterations of myocardial contractility demonstrated in echocardiograph and ventriculograph findings, was described. The so called Takotsubo syndrome is characterized by a reduction in contractility of apical myocardial segments and hyper-contractility of basal segments of left ventricle 7 . Other IntroductionThe myocardial perfusion radionuclide imaging has been applied in medical practice as an important tool for the diagnosis of myocardial ischemia. Is value on such diagnosis has been widely studied, which allows its utilization in patients admitted in emergency units and ambulatories 1 . However, a group of patients may relate thoracic ...

The prognostic study of mental stress-induced myocardial ischemia in coronary revascularization patients with depression/anxiety: rationale and design

“…The mental stress protocol includes the Stroop color word test (SCWT), which conflicts with the color and meaning. The SCWT is well-accepted and has good reproducibility amongst CAD patients [ 24 ]. The SCWT process has been detailed in previously published articles [ 25 ].…”

“…The scanning and post-processing processes have been explained in detail in previous articles [ 25 ]. Tridimensional reconstruction of the left ventricle will be performed to assess ventricular function, in addition to analyzing ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), contractility, and myocardial thickness [ 24 ]. Four abnormal SPECT phenomena will be considered positive for MISIMI [ 26 , 27 ], including reversable myocardial perfusion defects (RMPD), transient ischemic dilation (TID), reverse redistribution (RR), and EF reduction of ≥ 5% [ 28 ] (see Fig.…”

The Prognostic Study of Mental Stress-induced Myocardial Ischemia in Coronary Revascularization Patients with Depression/Anxiety: Rationale and Design

“…The mental stress protocol includes the Stroop color word test (SCWT), which con icts with the color and meaning. The SCWT is well-accepted and has good reproducibility amongst CAD patients [24]. The SCWT process has been detailed in previously-published articles [25].…”

“…The scanning and post-processing processes have been explained in detail in previous articles [25]. Tridimensional reconstruction of the left ventricle will be performed to assess ventricular function, in addition to analyzing ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), contractility, and myocardial thickness [24]. Four abnormal SPECT phenomena will be considered positive for MISIMI [26,27], including reversable myocardial perfusion defects (RMPD), transient ischemic dilation (TID), reverse redistribution (RR), and EF reduction of ≥ 5%[28] (see Fig.…”

Análise, por meio de telemetria, da evolução temporal da pressão arterial e frequência cardíaca, em ratos submetidos a estresse crônico

“…No entanto, a cronificação deste processo devido à falha e/ou ausência de mecanismos adaptativos, causa uma série de respostas deletérias que podem comprometer o estado de saúde físico e mental do indivíduo (Ursin e Eriksen, 2004;Charmandari et al, 2005;Nicolaides et al, 2015). Além de isquemia miocárdica (Barbirato et al, 2010), cardiomiopatia (Lemos et al, 2008) e formação de placas ateroscleróticas (Mcewen, 2005), a hipertensão arterial é uma das complicações desencadeadas pelo estresse crônico, uma doença altamente prevalente que afeta aproximadamente 80 milhões de pessoas nos Estados Unidos e 1 bilhão de indivíduos em todo o mundo (Mozaffarian et al, 2015), sendo a principal causa de doenças e perda geral da saúde (Lim et al, 2013). O cérebro é um dos principais órgãos alvo afetados pela hipertensão arterial.…”