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Role of behavioral and psychological factors in mental stress-induced silent left ventricular dysfunction in coronary artery disease
Role of behavioral and psychological factors in mental stress-induced silent left ventricular dysfunction in coronary artery disease
- Source :
- Journal of the American College of Cardiology. 22(2):440-448
- Publication Year :
- 1993
- Publisher :
- Elsevier BV, 1993.
-
Abstract
- Objectives. We examined the relationship of the psychological profile to left ventricular dysfunction induced during mental stress.Background. The contribution of psychological factors to mental stress-provoked silent myocardial ischemia has not been explored.Methods. Thirty patients with chronic stable coronary artery disease and a reversible defect on stress thallium-201 imaging completed a psychological assessment by questionnaire and Structured Interview, serially administered mental stress and brief walking exercise. Blood pressure, electrocardiogram (ECG) and left ventricular indexes were obtained by ambulatory serial radionuclide ventriculography. Silent ventricular dysfunction was defined by a decrease ≥0.05 in ejection fraction or ≥1 mm in ST segment on the ECG in the absence of symptoms.Results. Of the 30 patients, 15 (Group I) had evidence of silent left ventricular dysfunction during mental arithmetic. The other 15 (Group II) showed no change. In addition, 18 of 30 patients had this dysfunction during the Structured Interview. Both ischemic and nonischemic groups developed comparable and significant increases in heart rate and blood pressure. Group I patients were distinguished by higher scores on measures of aggressive responding (p < 0.001), trait anger (p < 0.0001), hostile affect (p < 0.003) and an index of behavioral reactivity (p < 0.003) and a lower score on anger control (p < 0.001). No other variables, including historical and clinical indexes, discriminated between the two groups.Conclusions. Patients with coronary artery disease and mental stress-provoked silent ventricular dysfunction were distinguished by a psychological profile consistent with emotional reactivity to social interaction and mental provocation, with anger as the predominant affective state. Patients with such a profile may be at risk of frequent silent left ventricular dysfunction.
- Subjects :
- Adult
medicine.medical_specialty
Heart disease
Coronary Disease
Radionuclide ventriculography
Asymptomatic
Ventricular Function, Left
Coronary artery disease
Internal medicine
Heart rate
medicine
Humans
cardiovascular diseases
Aged
Psychological Tests
Ejection fraction
business.industry
Stroke Volume
Type A Personality
Stroke volume
Middle Aged
medicine.disease
Blood pressure
Multivariate Analysis
Cardiology
medicine.symptom
business
Cardiology and Cardiovascular Medicine
Stress, Psychological
Subjects
Details
- ISSN :
- 07351097
- Volume :
- 22
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Journal of the American College of Cardiology
- Accession number :
- edsair.doi.dedup.....5431d59362aaadf2e18683e77c2c9ac2
- Full Text :
- https://doi.org/10.1016/0735-1097(93)90048-6