title: Mental stress-induced myocardial ischemia in women with angina and normal coronary angiograms.
abstract: 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.
authors.affiliation: Nuclear Medicine Department, Institute of Cardiology, La Habana, Cuba. peix@infomed.sld.cu
authors.forename: Amalia
authors.initials: A
authors.lastname: Peix
authors.forename: Angelina
authors.initials: A
authors.lastname: Trápaga
authors.forename: Lucrecia
authors.initials: L
authors.lastname: Asen
authors.forename: Felizardo
authors.initials: F
authors.lastname: Ponce
authors.forename: Olga
authors.initials: O
authors.lastname: Infante
authors.forename: Juan
authors.initials: J
authors.lastname: Valiente
authors.forename: Francisco
authors.initials: F
authors.lastname: Tornés
authors.forename: Lázaro O
authors.initials: LO
authors.lastname: Cabrera
authors.forename: Israel
authors.initials: I
authors.lastname: Guerrero
authors.forename: Ernesto J
authors.initials: EJ
authors.lastname: García
authors.forename: Regla
authors.initials: R
authors.lastname: Carrillo
authors.forename: David
authors.initials: D
authors.lastname: García-Barreto
mesh_terms: 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