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Mental Stress and Its Effects on Vascular Health
2022, Mayo Clinic ProceedingsCitation Excerpt :Thus, MSIMI is the downstream clinical manifestation of the combined physiologic effects of increased heart rate and blood pressure, endothelial dysfunction, and altered coronary blood flow70 in response to MS. Interestingly, angiographically normal epicardial coronary arteries show vasodilatation and increased coronary blood flow in the setting of MS.165 Conversely, MS is associated with local vasoconstriction in segments with epicardial atherosclerotic disease and stenosis, although the reductions in coronary blood flow are above and beyond that which can be explained by epicardial vasoconstriction alone, implicating the role of stress-induced increases in the resistance of the coronary microcirculation.166 This was confirmed in a study using coronary Doppler flow, which showed greater microvascular resistance in the setting of MS in patients with nonobstructive CAD.167 Further, patients with CAD exposed to MS while undergoing myocardial perfusion imaging had reduced coronary blood flow in territories without epicardial stenosis, suggesting the presence of heightened microvascular resistance.166
Brain-heart connections in stress and cardiovascular disease: Implications for the cardiac patient
2021, AtherosclerosisCitation Excerpt :Over the past decade, we centered efforts on the effects of acute psychological stress as measured experimentally in the laboratory on cardiovascular physiology, immune function, myocardial ischemia, neurobiology and cardiovascular outcomes in men and women with CVD [18–28]. Others have also reported that acute mental stress is associated with abnormal coronary reactivity, plaque rupture, as well as cardiac arrhythmias [22,29–33]. We have developed the concept that stress and mental health are especially important in influencing cardiovascular outcomes in patient subgroups such as women, patients with an early-onset myocardial infarction (MI), and patients with adverse psychosocial exposures [19,23,24,26,28,34–36].
Angina in Patients with Evidence of Myocardial Ischemia and No Obstructive Coronary Artery Disease
2018, Chronic Coronary Artery Disease: A Companion to Braunwald's Heart DiseaseHemodynamic, catecholamine, vasomotor and vascular responses: Determinants of myocardial ischemia during mental stress
2017, International Journal of CardiologyCitation Excerpt :These factors may explain why MSIMI occurs at lower workloads in comparison to exercise stress-induced myocardial ischemia [12]. Furthermore, significant epicardial coronary arterial vasoconstriction has been observed in response to mental stress in coronary segments with underlying atherosclerosis [18,44–46]. Consistent with this, we found that patients with CSIMI who have stronger hemodynamic and vasoconstrictor responses to mental stress are at highest risk of developing MSIMI.
Angina in Patients with Evidence of Myocardial Ischemia and No Obstructive Coronary Artery Disease
2017, Chronic Coronary Artery Disease: A Companion to Braunwald's Heart Disease