Mental stress as a trigger of acute cardiac events: the role of laboratory studies.
Mental stress has long been implicated as a potential trigger of myocardial infarction and sudden cardiac death. This article reviews research conducted in the past two decades utilizing laboratory studies to investigate behaviorally-induced pathophysiological effects (including increased cardiac demand, decreased myocardial supply, and impaired dilation of coronary resistance vessels), in patients with coronary artery disease. The clinical significance of mental stress-induced ischemia is supported by findings of a predictive relationship of mental stress-induced ischemia for ambulatory ischemia and subsequent cardiac events. Mental stress-induced ventricular fibrillation, ventricular tachycardia, and T-wave alternans are also being explored as possible markers of arrhythmic vulnerability in human and animal models. T-wave alternans comparable to exercise can be induced by an anger-like state in an animal model, and with mental stress in patients with implantable cardioverter-defibrillators. Future directions for research on mental stress and cardiac events are suggested, including further studies of mechanisms of mental stress-induced arrhythmia and ischemia, additional studies of the prognostic significance of stress-induced ischemia and T-wave alternans, and use of pharmacological and psychosocial treatments for preventing stress-induced cardiac events.
Krantz
D S
DS
Department of Medical and Clinical Psychology, Uniformed Services, University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, USA. krantz@bob.usuhs.mil
Quigley
J F
JF
O'Callahan
M
M
D000208:Acute Disease; D000818:Animals; D019411:Clinical Laboratory Techniques / Q000639:trends; D005544:Forecasting; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015995:Prevalence; D011379:Prognosis; D013315:Stress, Psychological / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology