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Mental Stress May Play Bigger Role in Heart Disease Than Previously Thought - Silent Ischemia without Chest Pain and Symptoms

March 7th 2006

Mental Stress May Play Bigger Role in Heart Disease Than Previously Thought - Silent Ischemia without Chest Pain and Symptoms

Human Heart

According to research from the University of Florida, heart disease patients could still pass stress tests done on a treadmill or with chemical stressors after treatment, their hearts may still suffer silent ischemia during mental stress.  Ischemia means that a heart, or other organ, does not get adequate blood flow and lacks vital oxygen and nutrients. 

The ischemia produced by mental stress has been associated with an increased risk of death in heart patients, who also suffer ischemia during physical stress.  David S. Sheps, M.D, said that the study just showed that mental stress ischemia can happen even in heart patients who are free of exercise-induced ischemia. The researchers are not sure whether the silent ischemia they detected is hazardous to the health of the patients.    

The researchers found that mental stress induced ischemia is more common than had been recognized before. The research supports proposals that suggest that mental stress works through a different mechanism than physical stress.


Dr. Sheps, who is from the University of Florida, Malcom Randall of the Veterans Administration Medical Center in Gainesville Florida, and the lead author Srikanth Ramachandruni, M.D., monitored the heart blood flow in 29 coronary heart disease patients as they performed a mentally stressful role-playing scenario.  All of the patients were being treated, but none shoed signs of ischemia on either the treadmill tests or after an injection of a chemical that puts stress on heart blood flow. 

Mental stress has been shown to produce ischemia in heart disease patients who also have problems during exercise or chemical stress tests, but this is the first such study specifically designed to look at this broader group of patients.


The patients were asked to imagine a stressful situation, such as learning that a relative was being mistreated in a nursing home, and then give a short speech demonstrating how they would respond.  After one minute into the speech, the participants were injected with a radioactive tracer.  Of the 29 participants, six showed signs of ischemia, although none of them felt chest pain or other symptoms of ischemia and there were no important differences in heart rate or blood pressure.

According to the American Heart Association (AHA), current data don't yet support specific recommendations about stress reduction as a proven therapy for cardiovascular disease.  This research may add to the evidence that suggests there is a relationship between cardiovascular disease and environmental and psychosocial factors.  The AHA also says that acute and chronic stress may affect other risk factors and behaviors, such as high blood pressure and cholesterol levels, smoking, physical inactivity and overeating.  The AHA says that after a heart attack or stroke, it is common for people who feel depressed, anxious or overwhelmed by stress should talk to their doctor or other healthcare professional. 

The new study appears in the Mar. 7, 2006, issue of the Journal of the American College of Cardiology.

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By Dan Wilson
Best Syndication Staff Writer

Books on Heart Disease

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Copyright 2005 Best Syndication                                            Last Updated Saturday, July 10, 2010 09:50 PM