Mental stress–induced myocardial ischemia in women with angina and normal coronary angiograms

Abstract

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.

Association between anxiety disorder and the extent of ischemia observed in cardiac syndrome X

“…A limitation of the study by Peix et al 26 is the nonstandard mental stress test, since it cannot be assumed that the subjects were exposed to similar levels of mental stress. We have attempted in our pilot study to avoid this limitation by using validated standardized questionnaires for anxiety disorders to measure the anxiety predispositions and levels of each CSX patient.…”

“…23 Previous work identified the importance of impaired myocardial blood flow, particularly in the microvascular bed, in relation to ischemia induced by mental stress, 24,25 and the phenomenon of endothelial dysfunction induced by mental stress has been described in CSX. 26 Sudden emotional stress can lead to myocardial stunning in healthy subjects without CAD, probably owing to exaggerated sympathetic stimulation that causes vasoconstriction. 33 Similarly, increased sympathetic tone from mental stress can cause vasoconstriction in patients without coronary disease, such as in CSX.…”

“…33 Similarly, increased sympathetic tone from mental stress can cause vasoconstriction in patients without coronary disease, such as in CSX. 33,34 The association between endothelial dysfunction and mental stress in CSX is reported in a SPECT study by Peix et al 26 CSX patients were asked to focus on an incident in their lives that made them very angry, and SPECT imaging was done during this period of mental stress. A total of 6 out of 16 patients had SPECT-imaged reversible perfusion defects, and this correlated with more frequent endothelial dysfunction measured by brachial artery flow-mediated dilation.…”

“…23 Previous work identified the importance of impaired myocardial blood flow, particularly in the microvascular bed, in relation to mental stress, 24,25 and the phenomenon of endothelial dysfunction induced by mental stress has been described in CSX. 26 Furthermore, CSX patients have significantly higher levels of anxiety. 27 Owing to the conflicting data regarding ischemia in CSX patients, and also the possible role of anxiety, we performed a pilot study to measure the extent of ischemia and anxiety levels in a group of CSX patients.…”

Role of Depressive Symptoms in Coronary Artery Spasm

“…In this regard, the current findings suggest that depression, a modifiable risk factor, may also play a potential role in a wide range of cardiovascular health issues [6] . Recent evidence suggests that mental stress may be associated with angina conditions without obstructive coronary angiographic findings [14,15] . Although these conditions are not homogenous, it may be presumed that endothelial dysfunction has an important role [14][15][16] .…”