The effect of mild-to-moderate mental stress on coronary hemodynamics in patients with coronary artery disease.

Abstract

SUMMARY Eleven men with coronary artery disease were studied to determine whether they would manifest inappropriate coronary vasoconstriction in response to mental stress. Mental stress was induced by having the patient perform difficult mental arithmetic in time with a clicking metronome. Aortic blood pressure and thermodilution coronary sinus blood flow were recorded continuously before and during the mental arithmetic. For the group, heart rate rose from 70 to 82 beats/min, systolic blood pressure rose from 161 to 181 mm Hg and diastolic blood pressure rose from 71 to 78 mm Hg. Coronary resistance decreased by 16%. The index of myocardial oxygen consumption rose by 40%, and there was an equivalent rise in coronary sinus blood flow of 41%, with no change in coronary arteriovenous oxygen difference.Because the increase in myocardial oxygen consumption was accompanied by a proportional increase in coronary sinus blood flow, a decrease in coronary resistance and no change in myocardial oxygen extraction, we conclude that the response of patients with coronary artery disease to at least moderately severe mental stress is not characterized by abnormal coronary vasoconstriction.THE PRESENT STUDY was carried out in men with ischemic heart disease to define the response of the human coronary vasculature to mental stress. In particular, we were seeking evidence for the existence of an abnormal vasomotor response (inappropriate coronary vasoconstriction) to mental stress. Mudge et al.' reported inappropriate coronary vasoconstriction in patients with coronary artery disease during exposure to cutaneous cold. The present study was designed to determine whether a similar response occurred with mental stress. MethodsEleven men ages 40-62 years who were undergoing cardiac catheterization and coronary arteriography as potential candidates for coronary bypass surgery were studied without prior sedation. All medication was discontinued 48 hours before the catheterization. Appropriate informed consent was obtained from each patient before the study. After standard right-heart catheterization, a #7 thermistor catheter (Wilton Webster Laboratories) was inserted into the coronary sinus for measurement of coronary sinus blood flow by the continuous thermodilution technique.2 The catheter was positioned under fluoroscopic guidance so that the external thermistor lay 5-10 mm inside the coronary sinus ostium as visualized by injection of 2-3 ml of contrast medium. The recording of the coronary sinus temperature by the thermistor showed a steady temperature, reflecting an absence of contamination

Circulatory effects of mental stress during exercise in coronary artery disease patients

“…Steady-state exercise routinely increases circulatory (heart rate, blood pressureo, pressure-rate product) parameters and oxygen uptake (Astrand and Rohdal, 1977). Sustained mental or emotional stress will also increase hemodynamic parameters (Bassan et al, 1980;Brod et al, 1959;DeBusk et al, 1979;Jelinek et al, 1977;Lown et al, 1978;Schiffer et al, 1976). We have shown that the combined hemodynamic effects of these two stressors are additive in young healthy, women without additive effects on oxygen consumption (Garber et al, 1983).…”

Fear of patients related to coronary arteriography

“…Admission to the hospital for CA is a fearful procedure for many patients. Studies have shown that stress can affect haemodynamic states ( Turton et al 1979 , Bassam et al 1980 ). When a tense patient finds it difficult to cooperate with the angiogram team, the duration and technical difficulties of the procedure can increase ( Anderson & Masur 1989).…”

Task-induced ST segment depression, ectopic beats, and autonomic responses in coronary heart disease patients.

“…The current results showed case-control differences in sympathetic response as well as specific correlations between this response and ST change. The failure of Bassan et al (39) to find such changes may be due to the brevity of their mental arithmetic task (2 to 2.5 min) and its difficulty. The task was described as impossible and may well not have induced the patients to actually perform the calculations.…”