Triggers of myocardial ischemia during daily life in patients with coronary artery disease: Physical and mental activities, anger and smoking

Abstract

Triggers of ischemia in patients with coronary artery disease during daily life include not only strenuous exercise, but also activities involving low levels of exertion, such as anger and smoking. Mental activities appear to be as potent as physical activities in triggering daily life ischemia. Coffee and alcohol consumption are related to ischemia only by virtue of their associations with smoking.

Hostility and anger expression behavioral and cardiovascular responses to mental stress among cardiovascular disease patients

“…While mental-stress induced ischemia can be observed reliably in the laboratory among CAD patients (e.g., Rozanski et al, 1988), it has also been observed during daily life activities using ambulatory monitoring devices and structured diaries (e.g., Gabbay et al, 1996;Gullette et al, 1997). These approaches thus help researchers observe the behaviors or specific stressful events which trigger ischemic episodes, and by extension, other cardiac events (Kop, 1999).…”

“…Electrocardiographic measures have been used in the laboratory and in ambulatory Holter monitoring to document how acute stress may elicit ischemia (Schiffer, Hartley, Schulman, & Abelmann, 1976;Gabbay et al, 1996).…”

“…A second example of ECG-assessed ischemia is that of Gabbay et al (1996), who reported on ambulatory ECG monitoring of 63 coronary artery disease patients. In comparing the continuous monitoring of the ECG to structured diaries of the patients' physical and mental activities, these researchers noted that ischemia occurred most frequently during moderately intense physical and mental activities.…”

“…The emotion of anger was reported as a trigger of myocardial ischemia by Gabbay et al (1996), with ischemia being nearly twice as likely to occur during times of high self-rated anger compared to times of low self-rated anger. Patients with CAD and evidence of out-of-hospital ischemia underwent ambulatory ECG monitoring for 24 to 48 hours while maintaining a validated structured diary regarding physical and mental activities and psychological state.…”

Variability of myocardial ischemic responses to mental versus exercise or adenosine stress in patients with coronary artery disease

“…2, 3 Several studies have shown that the development of myocardial ischemia in this setting, predicts ischemia during daily life, is a poor prognostic factor and is linked to fatal and nonfatal cardiac events in patients with CAD. [2][3][4][5][6][7][8] Exercise or adenosine stress testing is commonly used in clinical settings as a risk stratification tool in patients with CAD. However there is evidence that these testing modalities may not adequately assess the likelihood of risk related to mental stress.…”