title: Effect of mental stress on hemodynamics and left ventricular diastolic function in patients with ischemic heart disease.
abstract: Mental stress is an important factor affecting cardiac function. We evaluated the effect of a mental calculation stress (MS) test on hemodynamics and left ventricular (LV) diastolic function in patients with ischemic heart disease, and compared the hemodynamic responses with a treadmill exercise test. Fifteen patients were studied. Seven had old myocardial infarction with significant coronary artery stenosis (group I) and 8 had chest pain syndrome with non-significant coronary artery stenosis (group II). The MS test was performed as follows: after memorizing 6 random numeral digits, patients repeated these numbers in reverse order for 5 min followed by serial subtraction of 1000 minus 17 for 5 min. Blood pressure (BP) and heart rate (HR) were measured every 1-5 min. Doppler mitral flow velocity (MFV) was recorded every 2-5 min. During the MS test, BP, HR, and rate pressure product increased by 38.3%, 17.3%, and 62.1% on average, respectively. Early diastolic MFV decreased by 10.0% in group I and 3.3% in group 11. First third filling rate of MFV decreased by 32.3% in group I and 22.8% in group II. A/E ratio increased by 39.3% in group I and 25.8% in group II. These data indicate that the MS test led to a deterioration in LV diastolic function. The MS test induced LV diastolic dysfunction to a greater extent in patients with significant coronary artery stenosis than in those without significant coronary stenosis. Myocardial ischemia may be induced by increased left ventricular afterload and/or vasoconstrictive reflex of coronary microcirculation.
authors.affiliation: Third Department of Internal Medicine, School of Medicine, Nagasaki University, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Okano
authors.forename: T
authors.initials: T
authors.lastname: Utsunomiya
authors.forename: K
authors.initials: K
authors.lastname: Yano
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000503:physiopathology* / Q000523:psychology*; D013315:Stress, Psychological / Q000503:physiopathology*; D016277:Ventricular Function, Left