Rozanski A, Bairey C N, Krantz D S, Friedman J, Resser K J, Morell M, Hilton-Chalfen S, Hestrin L, Bietendorf J, Berman D S
Department of Medicine, University of California at Los Angeles School of Medicine.
N Engl J Med. 1988 Apr 21;318(16):1005-12. doi: 10.1056/NEJM198804213181601.
To assess the causal relation between acute mental stress and myocardial ischemia, we evaluated cardiac function in selected patients during a series of mental tasks (arithmetic, the Stroop color--word task, simulated public speaking, and reading) and compared the responses with those induced by exercise. Thirty-nine patients with coronary artery disease and 12 controls were studied by radionuclide ventriculography. Of the patients with coronary artery disease, 23 (59 percent) had wall-motion abnormalities during periods of mental stress and 14 (36 percent) had a fall in ejection fraction of more than 5 percentage points. Ischemia induced by mental stress was symptomatically "silent" in 19 of the 23 patients with wall-motion abnormalities (83 percent) and occurred at lower heart rates than exercise-induced ischemia (P less than 0.05). In contrast, we observed comparable elevations in arterial pressure during ischemia induced by mental stress and ischemia induced by exercise. A personally relevant, emotionally arousing speaking task induced more frequent and greater regional wall-motion abnormalities than did less specific cognitive tasks causing mental stress (P less than 0.05). The magnitude of cardiac dysfunction induced by the speaking task was similar to that induced by exercise. Personally relevant mental stress may be an important precipitant of myocardial ischemia--often silent--in patients with coronary artery disease. Further examination of the pathophysiologic mechanisms responsible for myocardial ischemia induced by mental stress could have important implications for the treatment of transient myocardial ischemia.
为评估急性精神应激与心肌缺血之间的因果关系，我们在一系列精神任务（算术、斯特鲁普色词任务、模拟公众演讲和阅读）期间对选定患者的心脏功能进行了评估，并将这些反应与运动诱发的反应进行了比较。通过放射性核素心室造影对39例冠心病患者和12例对照者进行了研究。在冠心病患者中，23例（59%）在精神应激期间出现壁运动异常，14例（36%）射血分数下降超过5个百分点。在23例壁运动异常患者中，19例（83%）精神应激诱发的缺血在症状上是“无症状的”，且发生时的心率低于运动诱发的缺血（P<0.05）。相比之下，我们观察到精神应激诱发的缺血和运动诱发的缺血期间动脉压有相当程度的升高。一项与个人相关、引起情绪激动的演讲任务比引起精神应激但特异性较低的认知任务诱发更频繁、更严重的局部壁运动异常（P<0.05）。演讲任务诱发的心功能障碍程度与运动诱发的相似。与个人相关的精神应激可能是冠心病患者心肌缺血（常为无症状性）的重要诱发因素。进一步研究精神应激诱发心肌缺血的病理生理机制可能对短暂性心肌缺血的治疗具有重要意义。
