title: Hemodynamic, hemostatic, and endothelial reactions to psychological and physical stress in coronary artery disease patients.
abstract: Episodes of psychological and physical stress may elicit thrombotic cardiac events, such as myocardial infarction. These events are triggered when there are concurrent hemodynamic, hemostatic, and endothelial abnormalities. Hemodynamic, hemostatic, and endothelial reactions of 72 (15 women, 57 men) coronary artery disease patients to psychological and physical stress were examined. Blood pressure, electrocardiography, and impedance cardiography were recorded during rest, mental arithmetic, and exercise. Blood was collected, via catheter, at rest and after each task. Mental arithmetic elicited increases in blood pressure, heart rate, cardiac output, and cardiac contractility, but no consistent changes in hemostatic and endothelial markers. In contrast, exercise, in addition to increasing blood pressure, heart rate, cardiac output, cardiac contractility, and lowering peripheral resistance, elicited increases in plasma viscosity, hematocrit, platelets, and tissue plasminogen activator together with a decrease in plasminogen activator inhibitor. This pattern of hemodynamic, hemostatic, and endothelial reactions suggests that acute psychological and physical stress influence the thrombotic system differently in these high risk patients. Future research is needed to investigate how these stress responses are prospectively related to acute cardiac events.
authors.affiliation: School of Sport and Exercise Sciences, University of Birmingham, Birmingham B15 2TT, UK. s_l_bacon@yahoo.ca
authors.forename: Simon L
authors.initials: SL
authors.lastname: Bacon
authors.forename: Christopher
authors.initials: C
authors.lastname: Ring
authors.forename: Foo Li Saw
authors.initials: FL
authors.lastname: Hee
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Blann
authors.forename: Kim L
authors.initials: KL
authors.lastname: Lavoie
authors.forename: Douglas
authors.initials: D
authors.lastname: Carroll
mesh_terms: D000208:Acute Disease; D015415:Biomarkers; D015992:Body Mass Index; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000503:physiopathology / Q000523:psychology; D004730:Endothelium, Vascular / Q000503:physiopathology*; D015444:Exercise; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology; D006487:Hemostasis / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008433:Mathematics; D008606:Mental Processes / Q000502:physiology; D008875:Middle Aged; D015849:Plasminogen Inactivators / Q000097:blood; D011446:Prospective Studies; D012720:Severity of Illness Index; D013312:Stress, Physiological / Q000503:physiopathology* / Q000523:psychology*; D010959:Tissue Plasminogen Activator / Q000097:blood
chemical_list: D015415:Biomarkers; D015849:Plasminogen Inactivators; D010959:Tissue Plasminogen Activator