title: Heart-brain interactions in mental stress-induced myocardial ischemia.
abstract: Myocardial ischemia that results from emotional provocation occurs in as many as 30% to 50% of patients with coronary artery disease during the discourse of their lives. This emotionally provoked or mental stress ischemia is associated with poor prognosis, with emerging treatment strategies. This article outlines the conceptual constructs that support the pathophysiologic underpinnings, and biobehavioral aspects associated with this mental stress ischemia. We review a biobehavioral model in which cognitive stress is transduced in the brain. The response of the brain to psychosocial stress is a highly sophisticated and integrated process by which sensory inputs are evaluated and appraised for their importance in relation to previous experience and current goals. The biologic consequences of such stress transduced in the central nervous system has its effect on cardiovascular flow and function through changes in autonomic balance, which result in various biologic processes that culminate in the perturbation of flow and function of the heart.
authors.affiliation: VA Connecticut Healthcare System, Yale University School of Medicine, 950 Campbell Avenue, West Haven, CT 06516, USA. robert.soufer@yale.edu
authors.forename: Robert
authors.initials: R
authors.lastname: Soufer
authors.forename: Hitender
authors.initials: H
authors.lastname: Jain
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Yoon
mesh_terms: D000223:Adaptation, Psychological; D001341:Autonomic Nervous System / Q000503:physiopathology; D001921:Brain / Q000503:physiopathology*; D003324:Coronary Artery Disease / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D007249:Inflammation / Q000503:physiopathology; D008297:Male; D008960:Models, Psychological; D017202:Myocardial Ischemia / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D009206:Myocardium / Q000473:pathology; D011379:Prognosis; D018570:Risk Assessment; D012737:Sex Factors; D013315:Stress, Psychological / Q000150:complications* / Q000503:physiopathology