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Mental stress as a trigger of myocardial ischemia and infarction
D S Krantz1, W J Kop, H T Santiago
1Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
Insights
Mental stress can trigger heart attacks in coronary artery disease patients. This review explores how stress impacts the cardiovascular system, potentially causing myocardial ischemia and other events.
Area of Science:
- Cardiology
- Psychosomatic Medicine
- Neurocardiology
Background:
- Coronary artery disease (CAD) patients are vulnerable to cardiovascular events.
- Mental stress is increasingly recognized as a trigger for acute cardiac events.
Purpose of the Study:
- To review evidence linking psychosocial stress to myocardial infarction (MI) in CAD patients.
- To explore the pathophysiological mechanisms of mental stress-induced ischemia.
Main Methods:
- Review of epidemiologic studies on psychosocial stress and MI.
- Examination of laboratory and field studies on mental stress and myocardial ischemia.
- Analysis of the central and autonomic nervous system pathways involved.
Main Results:
- Psychosocial stress acts as an acute trigger for MI in individuals with pre-existing CAD.
- Mental stress initiates physiological responses that can lead to myocardial ischemia, plaque rupture, and thrombosis.
- Vulnerability to stress-induced ischemia has clinical significance.
Conclusions:
- Mental stress poses a significant risk for triggering acute cardiovascular events in CAD patients.
- Understanding the stress-cardiac link is crucial for managing patients with coronary artery disease.
- Further research is warranted to elucidate the clinical significance of stress-induced ischemia.
Abstract:
Recent research on the effects of behavioral activities on myocardial ischemia in coronary artery disease patients has provided a pathophysiologic model for understanding the mechanisms by which mental stress can trigger clinical cardiovascular events. This article reviews epidemiologic research implicating psychosocial stress as an acute trigger of myocardial infarction in patients with pre-existing coronary artery disease, and evidence for the pathophysiologic effects of acute mental stress in individuals with pre-existing coronary artery disease. Via its actions on the central and autonomic nervous systems, stress can produce a cascade of physiologic responses in vulnerable individuals that may lead to myocardial ischemia, ventricular fibrillation, plaque rupture, or coronary thrombosis. Also reviewed are field and laboratory studies that suggest important causal links between mental stress and myocardial ischemia, and evidence suggesting clinical significance for vulnerability to mental stress-induced ischemia.