The Effect of Atherosclerosis on the Vasomotor Response of Coronary Arteries to Mental Stress

Abstract

Atherosclerosis disturbs the normal vasomotor response (no change or dilation) of large coronary arteries to mental stress; in patients with atherosclerosis paradoxical constriction occurs during mental stress, particularly at points of stenosis. This vasomotor response correlates with the extent of atherosclerosis in the artery and with the endothelium-dependent response to an infusion of acetylcholine. These data suggest that in atherosclerosis unopposed constriction caused by a local failure of endothelium-dependent dilation causes the coronary arteries to respond abnormally to mental stress.

Endothelial dysfunction in cardiovascular disease and Flammer syndrome—similarities and differences

“…Several other techniques employ invasive quantitative coronary angiography or intravascular ultrasound with exercise [30] or mental stress (calculating) [31] as it allows for immediate observation of a clinically important vasculature. A test that relies on sympathetic mediation for NO release is the cold pressor test: A subject submerges her hand for 2 min in ice water.…”

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

“…In other words, in patients with heart disease, coronary arteries that would under normal circumstances dilate in response to increased demand actually constrict. This paradoxical vasoconstriction was found in one study to be correlated to the extent of atherosclerosis in the affected artery, and endotheliumdependent responding to an acetylcholine challenge (Yeung et al, 1991). In a more recent study of vasomotion a CAD population, using the same set of participants as those presented for the current study proposal, this paradoxical vasoconstriction was not found overall in diseased segments of coronary arteries (Kop et al, 2001).…”

“…Studies have noted a 'paradoxical vasoconstriction' in diseased coronary arteries in responses to physical and mental stress (Nabel, Selwyn, & Ganz, 1990;Yeung et al, 1991). In other words, in patients with heart disease, coronary arteries that would under normal circumstances dilate in response to increased demand actually constrict.…”

Update in Internal Medicine

“…In addition, studies demonstrate that mental stress during daily life activities precipitates MI in at-risk populations. Mental stress appears to correlate with the extent and progression of atherosclerosis in the carotid arteries and appears to increase the risk for later clinical events among post-MI patients (14). Cognitive behavioral stress management and relaxation techniques appear to effectively diminish cardiovascular responses to acute stressors.…”