Neurocardiac Interaction During Stress-Induced Myocardial Ischemia

“My life is in the hands of any rascal who chooses to put me in a passion.” — —Sir John Hunter This quote from one of the major medical figures of the 18th century describes the association of his expression of anger to his experience of angina.1 In 1793, Dr Hunter was engaged in rancorous argument during the course of a faculty meeting and died suddenly. Narrative reports of angina pectoris in association with an individual’s experience of provocative, stressful circumstances, although not as dramatic as that made by Hunter, date from the time of Celsus to the dawn of modern medicine. These observations gave rise to the pioneering work of Rosenman et al2 on what they came to call “behavior pattern A.” Their work in turn encouraged others to pursue constitutional factors—the personality—that might give rise to risk for stress-related effects on the heart. The resulting literature on emotion, personality, and coronary artery disease (CAD) has, however, very often dealt with narrow concerns, without sufficient integration of biological and social variables that reflect the contextual nature of psychosocial stress. In addition, methodological drift in the conduct of studies on Type A and associated personality factors, combined with the failure in studies to account for concurrent progress in the care of the cardiac patient, produced results that conflicted with the earlier, promising findings.2 These issues have been discussed elsewhere.3 Hence, although we intuitively continue to link emotional factors and coronary syndromes, the nature of the link remains unclear. One consequence of the conflicting research findings on stress, emotion, and coronary syndromes is the absence of a conceptual framework, which is necessary if an effect on clinical awareness and practice is to be realized. In our pursuit of this framework, few discriminators are available to guide our …