MENTAL STRESS AS A TRIGGER OF MYOCARDIAL ISCHEMIA AND INFARCTION**Preparation of this article was assisted by a grant from the NIH (HL47337) and USUHS grant RO7233. The opinions and assertions expressed herein are those of the authors and are not to be construed as reflecting the views of the USUHS or the US Department of Defense.
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.
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Acute life events and chronic difficulties increase risk for a wide variety of mental and physical health problems, including anxiety disorders, depression, autoimmune disorders, cardiovascular disease, certain cancers, and Alzheimer's disease.
“The resulting consensus from this body of work is that acute life events (e.g., getting divorced or fired from a job) and chronic difficulties (e.g., ongoing marital or financial problems) increase risk for a wide variety of mental and physical health problems, including anxiety disorders, depression, autoimmune disorders, cardiovascular disease, certain cancers, and Alzheimer's disease (6–10).”
From Assessing Lifetime Stress Exposure Using the Stress and Adversity Inventory for Adults (Adult STRAIN): An Overview and Initial Validation (2018) · cites this paper as [8]
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Slavich, G. M., & Shields, G. S. (2018) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000534 · Cited by 268 · see citing works
Cytokines and immune activation in systolic heart failure: the role of Type D personality
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Psychopharmacology and Cardiovascular Disease
Piña, I. L., Di Palo, K. E., & Ventura, H. O. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.03.458 · Cited by 126 · see citing works
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Current Perspective on Mental Stress–Induced Myocardial Ischemia
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Self-citation
- Authors
- Krantz, D. S., Kop, W. J., Santiago, H. T., & Gottdiener, J. S.
- Affiliations
- Uniformed Services University of the Health Sciences (US)
- Venue
- Cardiology Clinics
- Publisher
- Elsevier BV
- Published
- 1996-05
- Volume
- 14
- Issue
- 2
- Pages
- 271-287
- ISSN
- 0733-8651 (ISSN-L)
- OpenAlex
- W2093441435
- Cited by
- 159
- References
- 2
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 1 · 2022: 4 · 2021: 6 · 2020: 4 · 2019: 4 · 2018: 4 · 2017: 3 · 2016: 6 · 2015: 3 · 2014: 5 · 2013: 8 · 2012: 7
- FWCI
- 3.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Cardiology Clinics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL047337, HL47337)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- psychological stress, myocardial ischemia, myocardial infarction, coronary artery disease, psychosocial stress, stress-induced arrhythmia, ventricular fibrillation, plaque rupture, coronary thrombosis, autonomic nervous system, stress vulnerability
- MeSH terms
- Heart Conduction System, Humans, Myocardial Infarction, Prognosis, Stress, Psychological, Vasoconstriction, Electrocardiography, Ambulatory, Myocardial Ischemia
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