Mental stress-induced myocardial ischemia in women with angina and normal coronary angiograms.
BACKGROUND
Coronary artery disease is frequent in postmenopausal women. Silent myocardial ischemia has been induced with mental stress testing.


RESULTS
To evaluate whether mental stress can induce ischemia in women with typical angina and normal coronary angiography, postmenopausal patients (n = 16) were studied. Each underwent technetium 99m methoxyisobutylisonitrile myocardial scintigraphy (exercise stress/rest/mental stress protocol), brachial artery endothelial function measurement by ultrasonography, and 24-hour ambulatory electrocardiographic recording (Holter). During mental stress testing, 6 patients (group I) had reversible perfusion defects on myocardial scintigraphy whereas the other 10 patients (group II) did not. Group I patients exhibited endothelial dysfunction more frequently than those in group II (83% vs 20%). Myocardial scintigraphy showed anteroapical/septal ischemia in 5 patients and inferoapical ischemia in one other patient, with both types of stress. Among group II patients, none showed a reversible perfusion defect during physical or mental stress. No group I patients had evidence of ischemia by Holter monitoring, whereas 2 of 10 group II patients did.


CONCLUSIONS
In postmenopausal women with typical angina and normal coronary arteries, mental stress may provoke myocardial ischemia, which can be concordant with ischemia induced by exercise stress, and is associated with endothelial dysfunction.
Peix
Amalia
A
Nuclear Medicine Department, Institute of Cardiology, La Habana, Cuba. peix@infomed.sld.cu
Trápaga
Angelina
A
Asen
Lucrecia
L
Ponce
Felizardo
F
Infante
Olga
O
Valiente
Juan
J
Tornés
Francisco
F
Cabrera
Lázaro O
LO
Guerrero
Israel
I
García
Ernesto J
EJ
Carrillo
Regla
R
García-Barreto
David
D
D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000209:etiology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000209:etiology*; D011877:Radionuclide Imaging; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications*; D016387:Women's Health