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Emotional stress response linked to coronary dysfunction in women
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Women with microvascular coronary dysfunction may experience more sympathetic nerve activity in response to emotional stress than women without coronary dysfunction, according to pilot study data presented at the American Psychosomatic Society Annual Scientific Meeting.
Researchers performed acute mental stress testing in 16 women with microvascular coronary dysfunction diagnosed via invasive coronary reactivity testing and in eight women without cardiac risk factors and normal results from an exercise stress test. The mental stress testing consisted of 4 minutes of anger recall, 4 minutes of mental arithmetic and a 3-minute forehead cold-pressor test. Researchers collected heart rate, BP and heart rate variability measurements at baseline and during testing.
"This is far from definitive, but it is supporting our hypothesis that women with coronary microvascular dysfunction have a disregulation of their autonomic nervous system,” researcher C. Noel Bairey Merz, MD, FACC, FAHA, director of the Barbra Streisand Women’s Heart Center, the Linda Joy Pollin Women’s Heart Health Program and the Preventive Cardiac Center at Cedars-Sinai Medical Center, told Cardiology Today. “Women, more so than men, have problems related to MI and threatened heart attacks like angina at relatively low heart rates, which would suggest that something else has to be going on."
C. Noel Bairey Merz
Similar changes to heart rate and systolic BP on mental stress testing occurred in both groups. Heart rate variability did not change during the mental arithmetic or cold-pressor tests, and the ratio of low- to high-frequency power, an indicator of sympathovagal balance, did not change in either group between baseline and testing.
During anger recall, sympathetic nerve activity increased and parasympathetic nerve activity decreased among patients with coronary dysfunction compared with controls, with increases to low frequency (0.04-0.15 Hz) power (0.26 median change vs. –0.83 among controls; P=.003) and decreases to high-frequency power (–0.41 vs. –1.19; P=.04).
“The observed cardiac autonomic pattern of relatively greater emotionally triggered cardiac sympathetic nerve stimulation implicates the cardiac autonomic nervous system as a potential mechanistic pathway for [microvascular coronary dysfunction] in the absence of obstructive CAD,” the researchers concluded. Bairey Merz added that additional research is currently underway incorporating a larger sample size, as well as the use of the MIBG radioisotope to evaluate the sympathetic nervous system endings in the heart.
"Angina at rest is more common in women, and the classic teaching is that you can just ignore it; what we're showing is that this can be a serious problem," said Bairey Merz, who is also a member of the Cardiology Today Editorial Board. "We're starting to understand the physiology of how the brain and the heart are linked, and that it does imply the autonomic nervous system." – by Adam Taliercio
For more information:
Mehta PK. Abstract #1270. Presented at: the American Psychosomatic Society Annual Scientific Meeting; March 12-15, 2014; San Francisco.
C. Noel Bairey Merz, MD, FACC, FAHA, can be reached at Cedars-Sinai Heart Institute, 127 S. San Vincente Blvd., Los Angeles, CA 90048.
Disclosure: Bairey Merz reports no relevant financial disclosures.