Mental Stress Triggers Myocardial Ischemia

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Summary and Comment

Mental Stress Triggers Myocardial Ischemia.

It is widely known that physical and emotional stress can lead to myocardial ischemia. However, the frequency with which these two stressors cause ischemia in the average patient and the types of stress that are most important have rarely been studied. Here, Duke University investigators examined the effect of stress on myocardial ischemia in 132 patients with known coronary disease and recent evidence of exercise-induced ischemia who underwent 48-hour ECG monitoring.

Of the 132 subjects, 58 exhibited evidence of ischemia on baseline ambulatory ECG monitoring and constituted the study group. Eighty-eight percent were male, the mean age was 59 years, and approximately 44 percent had a history of prior MI. Sixty percent reported a history of either angioplasty or bypass surgery. Nineteen percent were diabetic and two-thirds had known hyperlipidemia. Only 12 percent were current smokers.

The 58 patients underwent 2,760 hours of monitoring, during which 388 episodes of ischemia were observed. The mean number of episodes per patient was 6.8, and their average duration was 9.3 minutes. Patient diaries reporting activity and mood allowed the investigators to assess the relation between patients' perceived physical or emotional stress and subsequent ischemia. After adjusting for time of day and physical activity level, tension was associated with a 2.2-fold higher likelihood of ischemia, as was a report of sadness or frustration. Similarly, heavy physical activity was associated with a 13.2-fold higher risk of ischemia, while moderate and light activity conferred a 2.1-fold higher risk. Interestingly, positive emotions, such as happiness and feeling in control, were correlated with a small decrease in ischemia.

Comment: This study, like others before it, suggests that mental stress, particularly that associated with negative emotions, significantly increases the risk of ischemia during daily life. It seems reasonable that efforts to reduce negative emotions could improve the relative ischemic burden for a given patient. However, the pharmacologic and nonpharmacologic methods that can achieve this most effectively have yet to be determined.

— KA Eagle

Published in Journal Watch Cardiology June 13, 1997