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Effect of mental stress on hemodynamics and left ventricular diastolic function in patients with ischemic heart
Y Okano1, T Utsunomiya, K Yano
1Third Department of Internal Medicine, School of Medicine, Nagasaki University, Japan.
Insights
Mental stress significantly impairs left ventricular diastolic function, especially in patients with coronary artery stenosis. This mental calculation stress test reveals cardiac strain and potential myocardial ischemia.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Medical Diagnostics
Background:
- Mental stress is a known factor influencing cardiac function.
- Assessing the impact of mental stress on cardiac hemodynamics and diastolic function is crucial for understanding cardiovascular health.
- Ischemic heart disease patients require careful evaluation of stress-induced cardiac changes.
Purpose of the Study:
- To evaluate the effect of a mental calculation stress (MS) test on hemodynamics and left ventricular (LV) diastolic function.
- To compare the hemodynamic responses of the MS test with a traditional treadmill exercise test.
- To determine if the MS test induces LV diastolic dysfunction and to assess its severity in patients with varying degrees of coronary artery stenosis.
Main Methods:
- A mental calculation stress (MS) test involving digit recall and serial subtraction was administered.
- Hemodynamic parameters including blood pressure (BP) and heart rate (HR) were monitored.
- Doppler mitral flow velocity (MFV) was recorded to assess left ventricular (LV) diastolic function.
Main Results:
- The MS test significantly increased BP, HR, and rate pressure product.
- Early diastolic MFV and first third filling rate of MFV decreased, indicating impaired LV diastolic function.
- LV diastolic dysfunction was more pronounced in patients with significant coronary artery stenosis compared to those without.
Conclusions:
- The mental calculation stress test effectively induces left ventricular (LV) diastolic dysfunction.
- The MS test is a valuable tool for revealing cardiac strain and potential myocardial ischemia in patients with ischemic heart disease.
- Increased LV afterload and coronary microcirculation vasoconstriction may contribute to MS-induced myocardial ischemia.
Abstract:
Mental stress is an important factor affecting cardiac function. We evaluated the effect of a mental calculation stress (MS) test on hemodynamics and left ventricular (LV) diastolic function in patients with ischemic heart disease, and compared the hemodynamic responses with a treadmill exercise test. Fifteen patients were studied. Seven had old myocardial infarction with significant coronary artery stenosis (group I) and 8 had chest pain syndrome with non-significant coronary artery stenosis (group II). The MS test was performed as follows: after memorizing 6 random numeral digits, patients repeated these numbers in reverse order for 5 min followed by serial subtraction of 1000 minus 17 for 5 min. Blood pressure (BP) and heart rate (HR) were measured every 1-5 min. Doppler mitral flow velocity (MFV) was recorded every 2-5 min. During the MS test, BP, HR, and rate pressure product increased by 38.3%, 17.3%, and 62.1% on average, respectively. Early diastolic MFV decreased by 10.0% in group I and 3.3% in group 11. First third filling rate of MFV decreased by 32.3% in group I and 22.8% in group II. A/E ratio increased by 39.3% in group I and 25.8% in group II. These data indicate that the MS test led to a deterioration in LV diastolic function. The MS test induced LV diastolic dysfunction to a greater extent in patients with significant coronary artery stenosis than in those without significant coronary stenosis. Myocardial ischemia may be induced by increased left ventricular afterload and/or vasoconstrictive reflex of coronary microcirculation.