Mental Stress-Induced Myocardial Ischemia: Prevalence, Clinical Significance, and Treatment Implications
Mental stress produces myocardial ischemia in a significant subgroup of patients with coronary heart disease (CHD), with prevalence estimates ranging from 20% to 70% in patients with CHD. Several biobehavioral factors are involved in mental stress-induced myocardial ischemia, including autonomic nervous system activation, neuroendocrine responses, and central nervous system-related pro- cesses in multiple systems, factors that increase cardiac demand and reduce coronary supply. Mental stress-induced myocardial ischemia is associated with an increased risk of subsequent poor prognosis and mortality. Both pharmacologic and non-pharmacologic interventions targeted at reducing mental stressinduced ischemic responses may be required in the management of patients with CHD. More studies are needed to identify effective interventions as well as understand the underlying pathological pathways between the brain and the heart.
