Abstract
Mental stress ischemia (MSI) is a recently recognized phenomenon defined by the occurrence of myocardial ischemia during the experience of mentally and/or emotionally stressful circumstances. A substantial research effort has been directed at improving our understanding of this phenomenon, and determining whether it has prognostic significance beyond that associated with the underlying, chronic coronary artery disease (CAD). This effort has also been directed toward determining whether it is possible to specifically treat this phenomenon, and whether treatment improves prognosis. In this chapter, I will first review the literature that describes this phenomenon, relying on both naturalistic and laboratory-based studies. I will then describe the research conducted on the pathophysiology that might underlie MSI, and follow this by a review of the literature concerning prognostic significance and treatment. I will end with a discussion of future directions for research. Rather than provide a comprehensive review of the literature, this chapter will be selective in the literature discussed, the general aim being to inform the reader about MSI.
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References
Holter NJ (1961) A new method for heart studies. Science 134:1214–1220
Bellet S, Roman L, Kostis J, Slater A (1968) Continuous electrocardiographic monitoring during automobile driving: studies in normal subjects and patients with coronary disease. Am J Cardiol 22:856–862
Stern S, Tsivoni D (1973) Dynamic changes in the ST-T segment during sleep in ischemic heart disease. Am J Cardiol 32:17–20
Pepine CJ, Schang SJ (1975) Antianginal response of coronary heart disease patients on long-term perhexiline maleate. Am J Cardiol 35:168
Schang SJ, Pepine CJ (1977) Transient asymptomatic S-T segment depression during daily activity. Am J Cardiol 39:396–402
Imperi GA, Pepine CJ (1986) Silent myocardial ischemia during daily activities: studies in asymptomatic patients and those with various forms of angina. Cardiol Clin 4:635–642
Schiffer F, Hartley LH, Schulman CL, Abelmann WH (1976) The quiz electrocardiogram: a new diagnostic and research technique for evaluating the relation between emotional stress and ischemic heart disease. Am J Cardiol 37:41–47
Schiffer F, Hartley LH, Schulman CL, Abelmann WH (1980) Evidence for emotionally induced coronary arterial spasm in patients with angina pectoris. Br Heart J 40:62–66
Deanfield JE, Shea M, Kensett M et al (1984) Silent myocardial ischemia due to mental stress. Lancet 2:1001–1004
Burg MM, Jain D, Soufer R et al (1993) Role of behavioral and psychological factors in mental stress induced silent left ventricular dysfunction in coronary artery disease. J Am Coll Cardiol 22:440–448
Helmers KF, Krantz DS, Howell RH et al (1993) Hostility and myocardial ischemia in coronary artery disease patients: evaluation by gender and ischemic index. Psychosom Med 55:29–36
Helmers KF, Krantz DS, Merz CN et al (1995) Defensive hostility: relationship to multiple markers of cardiac ischemia in patients with coronary disease. Health Psychol 14:202–209
Ironson G, Taylor CB, Boltwood M et al (1992) Effects of anger on left ventricular ejection fraction in coronary artery disease. Am J Cardiol 70:281–285
Boltwood MD, Taylor CB, Burke MB et al (1993) Anger report predicts coronary artery vasomotor response to mental stress in atherosclerotic segments. Am J Cardiol 72:1361–1365
Gabbay FH, Krantz DS, Kop WJ et al (1996) Triggers of myocardial ischemia during daily life in patients with coronary artery disease: physical and mental activities, anger and smoking. J Am Coll Cardiol 27:585–592
Barry J, Selwyn AP, Nabel EG et al (1988) Frequency of ST-segment depression produced by mental stress in stable angina pectoris from coronary artery disease. Am J Cardiol 61:989–993
Gullette ECD, Blumenthal JA, Babyak M et al (1997) Effects of mental stress on myocardial ischemia during daily life. JAMA 277:1521–1526
Freeman LJ, Nixon PGF, Sllabank P, Reaveley D (1987) Psychological stress and silent myocardial ischemia. Am Heart J 114:477–482
Carels RA, Sherwood A, Babyak M et al (1999) Emotional responsivity and transient myocardial ischemia. J Consult Clin Psychol 67:605–610
Jain D, Joska T, Lee FA et al (2001) Day-to-day reproducibility of mental stress-induced abnormal left ventricular function response in patients with coronary artery disease and its relationship to autonomic activation. J Nucl Cardiol 8:347–355
Carney RM, McMahon RP, Freedland KE et al (1998) Reproducibility of mental stress-induced myocardial ischemia in the pathophysiological investigations of myocardial ischemia (PIMI). Psychosom Med 60:64–70
Kim CK, Bartholomew BA, Mastin ST et al (2003) Detection and reproducibility of mental stress induced ischemia with Tc-99m sestamibi SPECT in normal and coronary artery disease populations. J Nucl Cardiol 10:56–62
Maseri A (1987) Role of coronary artery spasm in symptomatic and silent myocardial ischemia. J Am Coll Cardiol 9:249–262
Chierchia S, Muiesan L, Davies A et al (1980) Role of the sympathetic nervous system in the pathogenesis of chronic stable angina: implications for the mechanism of action of β-blockers. Circulation 82(suppl II): 71–81
Yeung AC, Vekshtein VI, Krantz DS et al (1991) The effect of atherosclerosis on the vasomotor response of coronary arteries to mental stress. N Engl J Med 325:1551–1556
Lacy CR, Contrada RJ, Robbins ML et al (1995) Coronary vasoconstriction induced by mental stress (simulated public speaking). Am J Cardiol 75:503–505
Goldberg AD, Becker LC, Bonsall R et al (1996) Ischemic, hemodynamic, and neurohormonal response to mental and exercise stress. Circulation 94:2402–2409
Jain D, Shakir S, Burg M et al (1998) Effect of mental stress on left ventricular and peripheral vascular performance in patients with coronary artery disease. J Am Coll Cardiol 31:1314–1322
Arrighi JA, Burg M, Cohen IS et al (2000) Myocardial blood flow response during mental stress in patients with coronary artery disease. Lancet 356:310–311
Sherwood A, Johnson K, Blumenthal JA, Hinderliter AL (1999) Enothelial function and hemodynamic responses during mental stress. Psychosom Med 61:365–370
Jain D, Burg MM, Soufer R, Zaret BL (1995) Prognostic implications of mental stress-induced silent left ventricular dysfunction in patients with stable angina pectoris. Am J Cardiol 76:31–35
Jiang W, Babyak M, Krantz DS et al (1996) Mental stress-induced myocardial ischemia and cardiac events. JAMA 275:1651–1656
Krantz DS, Santiago HT, Kop WJ et al (1999) Prognostic value of mental stress testing in coronary artery disease. Am J Cardiol 84:1292–1297
Sheps DS, McMahon RP, Becker L, Carney RM (2002) Mental stress-induced ischemia and all-cause mortality in patients with coronary artery disease. Circulation 105:1780–1784
Blumenthal JA, Jiang W, Babyak MA et al (1997) Stress management and exercise training in cardiac patients with myocardial ischemia. Arch Int Med 157:2213–2223
Blumenthal JA, Babyak M, Jiang W, O’Connor C (2002) Usefulness of psychosocial treatment of mental stress-induced ischemia in men. Am J Cardiol 89:164–168
Kop WJ, Verdino RJ, Gottdeiner JS, O’Leary ST (2001) Changes in heart rate and heart rate variability before ischemic events. J Am Coll Cardiol 38:742–749
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Burg, M.M. (2006). Mental Stress Ischemia: Characteristics, Pathophysiology, Prognosis and Treatment. In: Clinical Psychology and Heart Disease. Springer, Milano. https://doi.org/10.1007/978-88-470-0378-1_5
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DOI: https://doi.org/10.1007/978-88-470-0378-1_5
Publisher Name: Springer, Milano
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