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. 1993;20(3):152–157.

Mental stress and myocardial ischemia. Correlates and potential interventions.

C N Merz 1, D S Krantz 1, A Rozanski 1
PMCID: PMC325087  PMID: 8219818

Abstract

In past years, indirect evidence has suggested a link between mental stress and coronary artery disease. Recent research in coronary artery disease patients has confirmed the observation that mental stress is a potent trigger of myocardial ischemia in both the laboratory and the field. The pathophysiologic effects of mental stress appear to operate via alterations in both myocardial oxygen demand and supply. Intense negative emotion, such as hostility, and heightened cardiovascular reactivity are positively associated with this ischemia, suggesting that recognition of these factors may help identify patient subgroups at highest risk. Preliminary studies evaluating pharmacologic intervention suggest that traditional anti-ischemia therapy, such as beta-blockers and vasodilators, can reduce mental-stress-triggered ischemia in coronary artery disease patients. Behavioral and psychosocial interventions, such as reducing environmental stress through social support, altering stress perception through behavioral training, and altering the physiologic reaction to stress through physical training, also show promise as therapeutic options. Further work is needed in this fertile biobehavioral area.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bairey C. N., Krantz D. S., DeQuattro V., Berman D. S., Rozanski A. Effect of beta-blockade on low heart rate-related ischemia during mental stress. J Am Coll Cardiol. 1991 May;17(6):1388–1395. doi: 10.1016/s0735-1097(10)80152-4. [DOI] [PubMed] [Google Scholar]
  2. Bairey C. N., Krantz D. S., Rozanski A. Mental stress as an acute trigger of ischemic left ventricular dysfunction and blood pressure elevation in coronary artery disease. Am J Cardiol. 1990 Nov 6;66(16):28G–31G. doi: 10.1016/0002-9149(90)90391-d. [DOI] [PubMed] [Google Scholar]
  3. Barry J., Selwyn A. P., Nabel E. G., Rocco M. B., Mead K., Campbell S., Rebecca G. Frequency of ST-segment depression produced by mental stress in stable angina pectoris from coronary artery disease. Am J Cardiol. 1988 May 1;61(13):989–993. doi: 10.1016/0002-9149(88)90112-9. [DOI] [PubMed] [Google Scholar]
  4. Blumenthal J. A., Emery C. F., Walsh M. A., Cox D. R., Kuhn C. M., Williams R. B., Williams R. S. Exercise training in healthy type A middle-aged men: effects on behavioral and cardiovascular responses. Psychosom Med. 1988 Jul-Aug;50(4):418–433. doi: 10.1097/00006842-198807000-00009. [DOI] [PubMed] [Google Scholar]
  5. Brackett C. D., Powell L. H. Psychosocial and physiological predictors of sudden cardiac death after healing of acute myocardial infarction. Am J Cardiol. 1988 May 1;61(13):979–983. doi: 10.1016/0002-9149(88)90110-5. [DOI] [PubMed] [Google Scholar]
  6. Breisblatt W. M., Weiland F. L., McLain J. R., Tomlinson G. C., Burns M. J., Spaccavento L. J. Usefulness of ambulatory radionuclide monitoring of left ventricular function early after acute myocardial infarction for predicting residual myocardial ischemia. Am J Cardiol. 1988 Nov 15;62(16):1005–1010. doi: 10.1016/0002-9149(88)90538-3. [DOI] [PubMed] [Google Scholar]
  7. Brown K. A., Boucher C. A., Okada R. D., Guiney T. E., Newell J. B., Strauss H. W., Pohost G. M. Prognostic value of exercise thallium-201 imaging in patients presenting for evaluation of chest pain. J Am Coll Cardiol. 1983 Apr;1(4):994–1001. doi: 10.1016/s0735-1097(83)80100-4. [DOI] [PubMed] [Google Scholar]
  8. Case R. B., Moss A. J., Case N., McDermott M., Eberly S. Living alone after myocardial infarction. Impact on prognosis. JAMA. 1992 Jan 22;267(4):515–519. [PubMed] [Google Scholar]
  9. Deanfield J. E., Shea M., Kensett M., Horlock P., Wilson R. A., de Landsheere C. M., Selwyn A. P. Silent myocardial ischaemia due to mental stress. Lancet. 1984 Nov 3;2(8410):1001–1005. doi: 10.1016/s0140-6736(84)91106-1. [DOI] [PubMed] [Google Scholar]
  10. Deedwania P. C., Carbajal E. V. Silent ischemia during daily life is an independent predictor of mortality in stable angina. Circulation. 1990 Mar;81(3):748–756. doi: 10.1161/01.cir.81.3.748. [DOI] [PubMed] [Google Scholar]
  11. Deedwania P. C., Nelson J. R. Pathophysiology of silent myocardial ischemia during daily life. Hemodynamic evaluation by simultaneous electrocardiographic and blood pressure monitoring. Circulation. 1990 Oct;82(4):1296–1304. doi: 10.1161/01.cir.82.4.1296. [DOI] [PubMed] [Google Scholar]
  12. Feigl E. O. The paradox of adrenergic coronary vasoconstriction. Circulation. 1987 Oct;76(4):737–745. doi: 10.1161/01.cir.76.4.737. [DOI] [PubMed] [Google Scholar]
  13. Folland E. D., Hamilton G. W., Larson S. M., Kennedy J. W., Williams D. L., Ritchie J. L. The radionuclide ejection fraction: a comparison of three radionuclide techniques with contrast angiography. J Nucl Med. 1977 Dec;18(12):1159–1166. [PubMed] [Google Scholar]
  14. Frasure-Smith N., Prince R. The ischemic heart disease life stress monitoring program: impact on mortality. Psychosom Med. 1985 Sep-Oct;47(5):431–445. doi: 10.1097/00006842-198509000-00003. [DOI] [PubMed] [Google Scholar]
  15. Helmers K. F., Krantz D. S., Howell R. H., Klein J., Bairey C. N., Rozanski A. Hostility and myocardial ischemia in coronary artery disease patients: evaluation by gender and ischemic index. Psychosom Med. 1993 Jan-Feb;55(1):29–36. doi: 10.1097/00006842-199301000-00006. [DOI] [PubMed] [Google Scholar]
  16. Krantz D. S., Helmers K. F., Bairey C. N., Nebel L. E., Hedges S. M., Rozanski A. Cardiovascular reactivity and mental stress-induced myocardial ischemia in patients with coronary artery disease. Psychosom Med. 1991 Jan-Feb;53(1):1–12. doi: 10.1097/00006842-199101000-00001. [DOI] [PubMed] [Google Scholar]
  17. Krantz D. S., Manuck S. B. Acute psychophysiologic reactivity and risk of cardiovascular disease: a review and methodologic critique. Psychol Bull. 1984 Nov;96(3):435–464. [PubMed] [Google Scholar]
  18. LaVeau P. J., Rozanski A., Krantz D. S., Cornell C. E., Cattanach L., Zaret B. L., Wackers F. J. Transient left ventricular dysfunction during provocative mental stress in patients with coronary artery disease. Am Heart J. 1989 Jul;118(1):1–8. doi: 10.1016/0002-8703(89)90064-1. [DOI] [PubMed] [Google Scholar]
  19. Ladenheim M. L., Pollock B. H., Rozanski A., Berman D. S., Staniloff H. M., Forrester J. S., Diamond G. A. Extent and severity of myocardial hypoperfusion as predictors of prognosis in patients with suspected coronary artery disease. J Am Coll Cardiol. 1986 Mar;7(3):464–471. doi: 10.1016/s0735-1097(86)80454-5. [DOI] [PubMed] [Google Scholar]
  20. McLenachan J. M., Weidinger F. F., Barry J., Yeung A., Nabel E. G., Rocco M. B., Selwyn A. P. Relations between heart rate, ischemia, and drug therapy during daily life in patients with coronary artery disease. Circulation. 1991 Apr;83(4):1263–1270. doi: 10.1161/01.cir.83.4.1263. [DOI] [PubMed] [Google Scholar]
  21. Nunes E. V., Frank K. A., Kornfeld D. S. Psychologic treatment for the type A behavior pattern and for coronary heart disease: a meta-analysis of the literature. Psychosom Med. 1987 Mar-Apr;49(2):159–173. doi: 10.1097/00006842-198703000-00006. [DOI] [PubMed] [Google Scholar]
  22. Panza J. A., Diodati J. G., Callahan T. S., Epstein S. E., Quyyumi A. A. Role of increases in heart rate in determining the occurrence and frequency of myocardial ischemia during daily life in patients with stable coronary artery disease. J Am Coll Cardiol. 1992 Nov 1;20(5):1092–1098. doi: 10.1016/0735-1097(92)90363-r. [DOI] [PubMed] [Google Scholar]
  23. Patterson S. M., Krantz D. S., Montgomery L. C., Deuster P. A., Hedges S. M., Nebel L. E. Automated physical activity monitoring: validation and comparison with physiological and self-report measures. Psychophysiology. 1993 May;30(3):296–305. doi: 10.1111/j.1469-8986.1993.tb03356.x. [DOI] [PubMed] [Google Scholar]
  24. Rosengren A., Tibblin G., Wilhelmsen L. Self-perceived psychological stress and incidence of coronary artery disease in middle-aged men. Am J Cardiol. 1991 Nov 1;68(11):1171–1175. doi: 10.1016/0002-9149(91)90189-r. [DOI] [PubMed] [Google Scholar]
  25. Rozanski A., Bairey C. N., Krantz D. S., Friedman J., Resser K. J., Morell M., Hilton-Chalfen S., Hestrin L., Bietendorf J., Berman D. S. Mental stress and the induction of silent myocardial ischemia in patients with coronary artery disease. N Engl J Med. 1988 Apr 21;318(16):1005–1012. doi: 10.1056/NEJM198804213181601. [DOI] [PubMed] [Google Scholar]
  26. Ruberman W., Weinblatt E., Goldberg J. D., Chaudhary B. S. Psychosocial influences on mortality after myocardial infarction. N Engl J Med. 1984 Aug 30;311(9):552–559. doi: 10.1056/NEJM198408303110902. [DOI] [PubMed] [Google Scholar]
  27. Tofler G. H., Stone P. H., Maclure M., Edelman E., Davis V. G., Robertson T., Antman E. M., Muller J. E. Analysis of possible triggers of acute myocardial infarction (the MILIS study). Am J Cardiol. 1990 Jul 1;66(1):22–27. doi: 10.1016/0002-9149(90)90729-k. [DOI] [PubMed] [Google Scholar]
  28. Tzivoni D., Gavish A., Zin D., Gottlieb S., Moriel M., Keren A., Banai S., Stern S. Prognostic significance of ischemic episodes in patients with previous myocardial infarction. Am J Cardiol. 1988 Oct 1;62(10 Pt 1):661–664. doi: 10.1016/0002-9149(88)91198-8. [DOI] [PubMed] [Google Scholar]
  29. Vita J. A., Treasure C. B., Yeung A. C., Vekshtein V. I., Fantasia G. M., Fish R. D., Ganz P., Selwyn A. P. Patients with evidence of coronary endothelial dysfunction as assessed by acetylcholine infusion demonstrate marked increase in sensitivity to constrictor effects of catecholamines. Circulation. 1992 Apr;85(4):1390–1397. doi: 10.1161/01.cir.85.4.1390. [DOI] [PubMed] [Google Scholar]
  30. Yeung A. C., Vekshtein V. I., Krantz D. S., Vita J. A., Ryan T. J., Jr, Ganz P., Selwyn A. P. The effect of atherosclerosis on the vasomotor response of coronary arteries to mental stress. N Engl J Med. 1991 Nov 28;325(22):1551–1556. doi: 10.1056/NEJM199111283252205. [DOI] [PubMed] [Google Scholar]

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