Proietti Riccardo, Mapelli Daniela, Volpe Biancarosa, Bartoletti Stefano, Sagone Antonio, Dal Bianco Lucia, Daliento Luciano
Electrophysiology Laboratory, Luigi Sacco Hospital, Milano, Italy.
Future Cardiol. 2011 May;7(3):425-37. doi: 10.2217/fca.11.13.
The connection between cardiovascular disease and psychosocial risk factors has been the subject of an ever-growing body of literature over the last 50 years. Studies on the role of negative emotions, personality traits, chronic stress and social determinants have brought to light their possible role in triggering acute coronary syndromes, although further studies are required to clarify controversial results regarding the association between cardiovascular risk and important psychological problems such as depression and anxiety. The recognition of the role of emotional events in acute coronary syndromes paved the way for provocation experiments, aimed at inducing mental stress in a controlled setting and then documenting reversible impairment of myocardial perfusion, depolarization anomalies and arrhythmias. This ultimately led to the formalization of the concept of mental stress-induced myocardial ischemia. Accumulating evidence on the mechanistic bases of such phenomena outline a wide range of central and peripheral physiological changes associated with emotions and behaviors, whose effects are exerted on the cardiovascular system, sympathetic nervous system and the hypothalamus-hypophysis neuroendocrine axis. This article outlines the main steps in the identification of psychological aspects as cardiovascular risk factors and emphasizes the relevance of emotional stress as a trigger of acute cardiovascular events. Finally, a description is provided of the pathophysiological mechanisms behind mental stress-induced myocardial ischemia and pathways connecting the heart and brain.
在过去50年里，心血管疾病与心理社会风险因素之间的联系一直是越来越多文献的主题。关于负面情绪、人格特质、慢性应激和社会决定因素作用的研究揭示了它们在引发急性冠状动脉综合征中可能发挥的作用，不过仍需要进一步研究来澄清关于心血管风险与诸如抑郁和焦虑等重要心理问题之间关联的有争议结果。对情绪事件在急性冠状动脉综合征中作用的认识为激发实验铺平了道路，这些实验旨在在可控环境中诱发精神压力，然后记录心肌灌注的可逆性损害、去极化异常和心律失常。这最终导致了精神压力诱发心肌缺血概念的正式确立。关于此类现象机制基础的证据不断积累，勾勒出了与情绪和行为相关的广泛中枢和外周生理变化，其作用施加于心血管系统、交感神经系统和下丘脑 - 垂体神经内分泌轴。本文概述了将心理因素确定为心血管风险因素的主要步骤，并强调了情绪应激作为急性心血管事件触发因素的相关性。最后，描述了精神压力诱发心肌缺血背后的病理生理机制以及连接心脏和大脑的途径。
