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Review
. 2022 Dec;24(12):2109-2120.
doi: 10.1007/s11886-022-01821-2. Epub 2022 Nov 2.

Mental Stress-Induced Myocardial Ischemia

Puja K Mehta  1 , Ashish Sharma  2 , J Douglas Bremner  3   4 , Viola Vaccarino  5   6
Affiliations
Review

Mental Stress-Induced Myocardial Ischemia

Puja K Mehta et al. Curr Cardiol Rep. 2022 Dec.

Abstract

Purpose of review: To summarize recent evidence on mental stress-induced myocardial ischemia (MSIMI), its mechanisms, and clinical significance.

Recent findings: MSIMI can occur in patients with normal cardiac stress testing, is only weakly related to severity of coronary artery disease (CAD), and it is often silent. Among patients with CAD, MSIMI is associated with a twofold increased risk of major adverse cardiovascular events compared to those who do not have MSIMI. Certain groups such as young women with myocardial infarction and those with psychological comorbidities are more susceptible to MSIMI. Abnormal microvascular vasoreactivity and inflammation are implicated mechanisms in MSIMI. Increased brain activity in regions that modulate autonomic reactivity to emotional stress and fear is associated with MSIMI. MSIMI has important prognostic implications in patients with CAD. Stress can no longer be ignored as a risk factor in cardiology care. Clinical trials testing effective strategies to target MSIMI are needed.

Keywords: Cardiovascular reactivity; Coronary vasospasm; Mental stress; Microvascular endothelial dysfunction.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Mechanisms of stress on cardiovascular physiology. Chronic and acute stressors contribute to an increased inflammatory response and autonomic imbalance, which can lead to adverse cardiometabolic effects, endothelial dysfunction, abnormal vascular reactivity, and abnormal immune function. These factors ultimately can contribute to adverse cardiovascular events. ACTH, adrenocorticotrophic hormone; CAM, cell adhesion molecules; E, epinephrine; HTN, hypertension; MMP, matrix metalloproteinases; NAFLD, nonalcoholic fatty liver disease; NE, norepinephrine; RAS, renin-angiotensin system. Figure created using BioRender.com
Fig. 2
Fig. 2
Correlates of mental stress-induced myocardial ischemia (MSIMI). MSIMI is associated with several factors and is a phenomenon that is not benign. MI, myocardial infarction; PTSD, post-traumatic stress disorder
Fig. 3
Fig. 3
Mental stress-induced myocardial ischemia and events in coronary artery disease. MSIMI is associated with twofold increased events in patients with CAD compared to those with no ischemia, and almost a fourfold increased risk when combined with conventional stress ischemia. MI, myocardial infarction. (Figure reprinted with permission from JAMA. 2021. 326(18): 1818–28. Copyright© (2021) American Medical Association. All rights reserved)
See this image and copyright information in PMC

References

    1. Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, et al. Heart Disease and Stroke Statistics-2021 update: a report from the American Heart Association. Circulation. 2021;143(8):e254–e743. doi: 10.1161/CIR.0000000000000950. - DOI - PubMed
    1. Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M, Almahmeed WA, et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):953–962. doi: 10.1016/S0140-6736(04)17019-0. - DOI - PubMed
    1. Sgoifo A, Montano N, Esler M, Vaccarino V. Stress, behavior and the heart. Neurosci Biobehav Rev. 2017;74(Pt B):257–259. doi: 10.1016/j.neubiorev.2016.11.003. - DOI - PMC - PubMed
    1. Kivimaki M, Steptoe A. Effects of stress on the development and progression of cardiovascular disease. Nat Rev Cardiol. 2018;15(4):215–229. doi: 10.1038/nrcardio.2017.189. - DOI - PubMed
    1. Dhaibar HA, Cruz-Topete D. Predisposition of Women to cardiovascular diseases: a side-effect of increased glucocorticoid signaling during the COVID-19 pandemic? Front Glob Womens Health. 2021;2:606833. doi: 10.3389/fgwh.2021.606833. - DOI - PMC - PubMed

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