Sympathetically mediated effects of mental stress on the cardiac microcirculation of patients with coronary artery disease

https://doi.org/10.1016/S0002-9149(99)80043-5Get rights and content

Abstract

Mental stress often causes myocardial ischemia in patients with coronary artery disease (CAD). There is increasing evidence mat the coronary microcirculation of patients with atherosclerosis may be dysfunctional, with the potential of contributing to myocardial ischemia. This study investigated sympathetically mediated coronary microcirculatory and regional noradrenergic effects of mental stress. We measured left anterior descending coronary artery blood flow and norepinephrine kinetics at rest and during a 10-minute video game in 10 CAD patients with nonsignificant atherosclerosis of this artery and in 5 patients with normal coronary angiograms (NCA). The 2 groups did not differ in their responses of systemic and cardiac norepinephrine spillovers, heart rate, and blood pressure during mental stress. Patients with NCA had microvascular dilation during mental stress (26 ± 9% [mean ± SD] decline in coronary vascular resistance from baseline, p < 0.01), whereas patients with CAD did not (9 ± 20% decline, p = 0.11). Six patients with CAD then received intracoronary hentolamine (1.7 ng/kg/min for 5 minutes, followed by 0.17 μg/kg/min) and played the video game again. In contrast to nonsignificant changes in coronary resistance during the initial video game (6 ± 15% decline, p = 0.20), coronary vascular resistance decreased significantly during the repeat video game (25 ± 19% decline, p = 0.02). Vasomotor responses of epicardial coronary artery segments did not differ between the 2 video game studies. Five other patients (4 with CAD, 1 with NCA) repeated the video game during intracoronary administration of 5% dextrose, with systemic and coronary hemodynamic and noradrenergic responses unchanged from those during the initial video game. Thus, the coronary microcirculation of patients with CAD fails to dilate during mental stress, a response likely mediated by α-adrenoceptor activation mat may contribute to myocardial ischemia.

Reference (23)

  • QuyyumiAA et al.

    Nitric oxide activity in the human coronary circulation: impact of risk factors for coronary atherosclerosis

    J Clin Invest

    (1995)
  • Cited by (128)

    • Mental Stress and Its Effects on Vascular Health

      2022, Mayo Clinic Proceedings
      Citation 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, Atherosclerosis
      Citation 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 Disease
    • Hemodynamic, catecholamine, vasomotor and vascular responses: Determinants of myocardial ischemia during mental stress

      2017, International Journal of Cardiology
      Citation 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
    View all citing articles on Scopus
    View full text