Mental Stress Induced Ischemia in the Laboratory and Ambulatory Ischemia During Daily Life : Association and Hemodynamic Features

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
Circulation (Impact Factor: 14.43). 10/1995; 92(8):2102-8. DOI: 10.1161/01.CIR.92.8.2102
Source: PubMed


The purpose of this study was to determine the correspondence of mental stress-induced ischemia in the laboratory with ambulatory ischemia and to assess the relationship between hemodynamic responses to mental stress and the occurrence of ischemia. Although exercise testing is usually used to elicit myocardial ischemia, ischemia during daily life usually occurs at relatively low heart rates and in the absence of strenuous physical exercise. Mental stress has been shown to trigger ischemic events in the laboratory at lower heart rates but at blood pressures comparable to exercise. We therefore compared the extent to which mental stress and exercise testing identify patients who develop ischemia out of hospital.
One hundred thirty-two patients with documented coronary disease and recent evidence of exercise-induced myocardial ischemia underwent 48-hour ambulatory monitoring and radionuclide ventriculography during exercise and mental stress testing. Patients who displayed mental stress-induced ischemia in the laboratory were more likely to exhibit ischemia during daily life (P < .021). Furthermore, patients who exhibited ischemia during ambulatory monitoring displayed larger diastolic blood pressure (P < .006), heart rate (P < .039), and rate-pressure product responses (P < .018) during mental stress.
Among patients with prior positive exercise stress tests, mental stress-induced ischemia, defined by new wall motion abnormalities, predicts daily ischemia independent of exercise-induced ischemia. Exaggerated hemodynamic responses during mental stress testing also identify individuals who are more likely to exhibit myocardial ischemia during daily life and mental stress.

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    • "This vasodilation in normal arteries appears to be mediated by the stimulation of α2 adrenergic receptors, which promote the release of nitric oxide. In CAD individuals, endothelial injury blocks these events, enabling MS to trigger coronary vasoconstriction and myocardial oxygen offer/demand imbalance [28,29]. Coronary artery spasm was presumed to be the mechanism involved in three cases of cardiac ischemia linked to PD [30]. "
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    ABSTRACT: Background Chest pain, a key element in the investigation of coronary artery disease is often regarded as a benign prognosis when present in panic attacks. However, panic disorder has been suggested as an independent risk factor for long-term prognosis of cardiovascular diseases and a trigger of acute myocardial infarction. Objective Faced with the extreme importance in differentiate from ischemic to non-ischemic chest pain, we report a case of panic attack induced by inhalation of 35% carbon dioxide triggering myocardial ischemia, documented by myocardial perfusion imaging study. Discussion Panic attack is undoubtedly a strong component of mental stress. Patients with coronary artery disease may present myocardial ischemia in mental stress response by two ways: an increase in coronary vasomotor tone or a sympathetic hyperactivity leading to a rise in myocardial oxygen consumption. Coronary artery spasm was presumed to be present in cases of cardiac ischemia linked to panic disorder. Possibly the carbon dioxide challenge test could trigger myocardial ischemia by the same mechanisms. Conclusion The use of mental stress has been suggested as an alternative method for myocardial ischemia investigation. Based on translational medicine objectives the use of CO2 challenge followed by Sestamibi SPECT could be a useful method to allow improved application of research-based knowledge to the medical field, specifically at the interface of PD and cardiovascular disease.
    International Archives of Medicine 08/2012; 5(1). DOI:10.1186/1755-7682-5-24 · 1.08 Impact Factor
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    • "Overall, evidence has shown that systemic vascular resistance (SVR) control of BP during mental stress is a marker of cardiovascular disease risk (Light & Sherwood, 1989; Sherwood & Turner, 1995). Exaggerated SVR response during mental stress has been associated with myocardial ischemia (Blumenthal et al., 1995). Moreover, SVR responses to stress are blunted during the high estrogen phase of the menstrual cycle (McFetridge & Sherwood, 2000). "
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    ABSTRACT: Standard noninvasive impedance cardiography has been used to examine the cardiovascular responses of individuals to a wide range of stimuli in critical care and laboratory settings. It has been shown to be a reliable alternative to invasive thermodilution techniques and an acceptable alternative to the use of a pulmonary artery catheter. Ambulatory impedance cardiography provides a similar assessment of cardiac function to standard noninvasive impedance cardiography, but it does so while individuals engage in activities of daily living. It offers portability and the option of managing complex patients in outpatient settings. To critically examine through a literature analysis the validity, reliability, and sensitivity of ambulatory impedance cardiography for the assessment of cardiac performance during activities of daily living. The Cochrane Database of Systematic Reviews (CDSR), The Cochrane Database of Methodology Reviews (CDMR), The Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), National Health Service Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA), and The Cochrane Methodology Register (CMR; 1966-2005); MEDLINE (1950-2005); and CINAHL (1982-2005) were searched using the following terms: ambulatory cardiac performance, impedance cardiac performance, AIM cardiac performance monitor, thoracic electrical bio-impedance, impedance cardiography, ambulatory impedance monitor, bio-impedance technology, ambulatory impedance cardiography, bio-electric impedance; also included were reference lists of retrieved articles. Studies were selected if they used an ambulatory impedance monitor to examine one or more of the following cardiovascular responses: pre-ejection period (PEP), left ventricular ejection time (LVET), stroke volume (SV), or a combination of these. Studies have been predominantly descriptive and have been focused on a young, male population with a normal body mass index (BMI; 25-29 kg/m). Inconsistencies in determining specific markers of cardiac function (e.g., PEP and SV) across studies necessitated that results be reported by outcome for each study separately. Ambulatory impedance monitors are valid and reliable instruments used for the physiologic measurement of cardiac performance. Sensitivity is established utilizing within-individual measurements of relative change. This is especially important in light of an aging population and technical advances in healthcare. Further research is warranted using nursing interventions that focus on an older, female population who have a BMI greater than 30 kg/m. Availability of noninvasive ambulatory measures of cardiac function has the potential to improve care for a variety of patient populations, including those with hypertension, heart failure, pain, anxiety, and depressive symptoms.
    Nursing Research 07/2006; 55(4):283-91. DOI:10.1097/00006199-200607000-00009 · 1.36 Impact Factor
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    • "Laboratory and ambulatory studies demonstrate a reliable relationship between hostility and larger and more frequent cardiovascular responses (Christensen and Smith, 1993; Guyll and Contrada, 1998; Shapiro et al., 1997). Studies have shown these physiological responses are also associated with atherosclerosis (Kamarck et al., 1997; Matthews et al., 1993) and myocardial ischemia in the laboratory (Blumenthal et al., 1995; Gottdiener et al., 1994; Krantz et al., 1991) and during daily life (Bairey et al., 1990; Gabbay et al., 1996; Legault et al., 1995). "
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    ABSTRACT: Recent models hypothesize that hostility confers increased risk of CHD through weaker parasympathetic dampening of cardiovascular reactivity (CVR). We tested this possibility using the forehead cold pressor task, a common maneuver which elicits the "dive reflex" characterized by a reflexive decrease in HR presumably through cardiac-parasympathetic stimulation. Participants were initially chosen from the outer quartiles of a sample of 670 undergraduates screened using the hostility subscale of the Aggression Questionnaire ([Buss, A.H., Perry, M., 1992. The Aggression Questionnaire. Journal of Personality and Social Psychology, 63, 452-459.]). The final sample of 80 participants was evenly divided between men and women and high and low hostility. Following a 10-min baseline, participants underwent a 3-min forehead cold pressor task. The task evoked a significant HR deceleration that was mediated by PNS activation, as assessed by respiratory sinus arrhythmia (RSA). Replicating prior research, men displayed greater decrease in HR. More important, low hostiles maintained larger HR deceleration over time compared to high hostiles although the autonomic basis for this effect was unclear. The findings broaden understanding of hostility and sex-related cardiovascular functioning and support the task as a method for evoking PNS-cardiac stimulation.
    International Journal of Psychophysiology 07/2006; 60(3):274-83. DOI:10.1016/j.ijpsycho.2005.07.005 · 2.88 Impact Factor
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