Mental stress-induced myocardial ischemia

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Mental stress-induced myocardial ischemia
SpecialtyCardiology
CausesReduced mental stress threshold levels affected by genetic predispositions and life experiences
FrequencyIn patients with stable coronary heart disease (CHD) up to 70%[1]

Mental stress-induced myocardial ischemia (MSIMI) is a medical condition in which acute psychological stress can trigger a transient myocardial ischemia, which is a state of reduced blood flow to the heart muscle, often without the presence of significant coronary artery disease (CAD).[2][3][4][5][1] It is distinct from conventional stress ischemia caused by physical exertion or pharmacological agents.[3] MSIMI is often silent and detected through specific cardiac function tests during mental stress challenges.[6]

Mechanism[edit]

Mental stress triggers various physiological changes in the body, activating mechanisms such as the autonomic nervous system (ANS) and the hypothalamic–pituitary–adrenal axis (HPA), resulting in hemodynamic, neuroendocrine, and immune responses. Typically, these responses are adaptive and help individuals cope with environmental changes, referred to as the "defense response," which prepares them for fight or flight. Consequently, the risk of cardiovascular (CV) events resulting from mental stress is influenced by external factors and an individual's stress threshold, which is shaped by genetic predispositions and life experiences. This variability explains why people respond differently to stressors.[5]

Mental stress-induced myocardial ischemia involves abnormal microvascular vasoreactivity and inflammation, with increased brain activity in regions that modulate autonomic nervous system reactivity to emotional stress, fear.[2][7] Emotional responses and certain psychological traits may influence the occurrence of MSIMI.[6] MSIMI can occur at lower cardiac workloads, independent of hemodynamic changes, and is not directly related to the severity of angiographic CHD.[3] It can occur in patients with normal cardiac stress testing and can often be silent.[2]

Clinical significance[edit]

MSIMI is associated with a twofold increased risk of major adverse cardiovascular events (MACE) compared to those without MSIMI. It is particularly prevalent among young women with myocardial infarction (MI) and those with psychological comorbidities.[2]

Studies have found that young women who have had a myocardial infarction are twice as likely to develop mental stress-induced myocardial ischemia (MSIMI) compared to men of similar age.[4]

Diagnostics[edit]

Various techniques like electrocardiogram (ECG), echocardiography, and positron emission tomography (PET) are used to assess MSIMI. The incidence of MSIMI has varied across studies due to different assessment methods and mental stressors.[6]

Treatment[edit]

Current research focuses on understanding stress pathways in CAD and integrating mental health, behavioral medicine with routine cardiology care to improve patient outcomes.[2]

Epidemiology[edit]

Approximately 30% of CAD patients experience MSIMI under mental stress, which typically is silent and not related to the severity of CAD.[6]

See also[edit]

References[edit]

  1. ^ a b "Mental Stress-Induced Myocardial Ischemia: An Under-Recognized Cardiac Risk Factor?". American College of Cardiology. Retrieved 2024-04-20.
  2. ^ a b c d e Mehta, Puja K.; Sharma, Ashish; Bremner, J. Douglas; Vaccarino, Viola (December 2022). "Mental Stress-Induced Myocardial Ischemia". Current Cardiology Reports. 24 (12): 2109–2120. doi:10.1007/s11886-022-01821-2. ISSN 1523-3782. PMC 9628301. PMID 36322365.
  3. ^ a b c Bravo, Paco E.; Cappola, Thomas P. (2021-11-09). "Mental Stress–Induced Myocardial Ischemia: When the Mind Controls the Fate of the Heart". JAMA. 326 (18): 1803–1804. doi:10.1001/jama.2021.18766. ISSN 0098-7484. PMC 9208308. PMID 34751723.
  4. ^ a b Vaccarino, Viola; Sullivan, Samaah; Hammadah, Muhammad; Wilmot, Kobina; Al Mheid, Ibhar; Ramadan, Ronnie; Elon, Lisa; Pimple, Pratik M.; Garcia, Ernest V.; Nye, Jonathon; Shah, Amit J.; Alkhoder, Ayman; Levantsevych, Oleksiy; Gay, Hawkins; Obideen, Malik (2018-02-20). "Mental Stress–Induced-Myocardial Ischemia in Young Patients With Recent Myocardial Infarction: Sex Differences and Mechanisms". Circulation. 137 (8): 794–805. doi:10.1161/CIRCULATIONAHA.117.030849. ISSN 0009-7322. PMC 5822741. PMID 29459465.
  5. ^ a b Vancheri, Federico; Longo, Giovanni; Vancheri, Edoardo; Henein, Michael Y. (January 2022). "Mental Stress and Cardiovascular Health—Part I". Journal of Clinical Medicine. 11 (12): 3353. doi:10.3390/jcm11123353. ISSN 2077-0383. PMC 9225328. PMID 35743423.
  6. ^ a b c d Strike, P (April 2003). "Systematic review of mental stress-induced myocardial ischaemia". European Heart Journal. 24 (8): 690–703. doi:10.1016/S0195-668X(02)00615-2. PMID 12713764.
  7. ^ Nan, Nan; Feng, Lei; Dong, Wei; Gao, Bingyu; Zuo, Huijuan; Mi, Hongzhi; Wang, Gang; Song, Xiantao; Zhang, Hongjia (2023-05-04). "The prognostic study of mental stress-induced myocardial ischemia in coronary revascularization patients with depression/anxiety: rationale and design". BMC Cardiovascular Disorders. 23 (1): 235. doi:10.1186/s12872-023-03246-3. ISSN 1471-2261. PMC 10157980. PMID 37142999.
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