Psychological stress doubles the pain of angina


The increase in brain activity due to experiencing a state of mental stress may have a relationship in stimulating angina pectoris in patients with CAD. This is what was reported by the results of a recent medical study by American researchers from Emory University in Atlanta, published in the current August 18 issue of the journal “Circulation: Cardiovascular Imaging”. The title of the two-year study was: “The association between activity in the lower frontal lobe of the cerebral cortex induced by mental stress and angina pectoris in coronary artery disease.”

heart attack

It is known that as a result of the presence of narrowing of the coronary arteries, blood flow to the heart muscle, Myocardial Ischemia, is often reduced, and then the patient may feel the pain of angina. It is also known that doctors divide the parts of the cortex anatomically into a number of lobes, which differ in their functions and their relationship to different parts and organs of the body.

In a previous study published in the April 2018 issue of the Journal of Psychosomatic Medicine, Emory University researchers reported that, in its summary: “It is clinically observed that severe mental states can lead to a heart attack. In vulnerable individuals. However, this condition is not broadly aware and has not been clearly evaluated clinically. There are only five previous medical studies about it, ”that is, to the year 2018. They added at the time, saying:“ The state of lack of myocardial perfusion as a result of mental stress – Induced Ischemia is a common phenomenon in patients suffering from coronary artery disease. The idea that stress could lead to myocardial ischemia was first described in 1984 using nuclear imaging of ischemic heart.

This recent study comes as a continuation of their previous research efforts in this field. In the introduction to the recent study, the researchers said: “The Inferior Frontal Lobe is an important region in the front of the brain, and it actively participates in the brain response to mental and psychological stress that a person experiences. A higher level of activity in this brain region indicates a higher-intensity brain reaction to stressful situations. However, it is not scientifically clear whether the increase in activity in this brain region, due to stress and psychological tension, is associated with angina pain in individuals with coronary artery disease.

Psychological stress

During the two-year study, the researchers adopted a comparative research approach to assess patients with stable cardiovascular disease Stable CAD when experiencing mental stress. Throughout the follow-up period, there were five elements that were repeatedly evaluated and attempted to understand the link between them, namely:

– Exposure to types of conditions that cause mental tension.

Response activity in the area of ​​psychological reaction in the brain, before and during exposure to these conditions.

The extent of angina pain, before and during exposure to these conditions.

The extent of changes in blood flow to different areas of the brain, before and during exposure to these conditions.

The extent of changes in blood flow to the heart muscle, before and during exposure to these conditions, and also when suffering from physical stress.

In the first component, the researchers used Stress – Inducing Protocols, which include verbal stress and mathematical calculations, and Speech / Arithmetic Stressors, which usually cause mental psychological stress.

The second and fourth components were evaluated by performing a high-resolution functional examination of the brain using High – Resolution Positron Emission Tomography, in order to monitor the intensity of activity in the lower frontal lobe and the rest of the brain regions, as well as to assess the extent of any changes in blood flow to the area of ​​psychological reaction. In the Brain Compared to the Rest of the Brain Regional: Total Brain Blood Flow.

In the third component, the clinical evaluation of the Seattle Angina scale was used for the extent of angina pain.

In the fifth component, changes in blood flow to the heart muscle, Myocardial Perfusion, were tracked, by performing MPI imaging during: rest, under stress, and during conventional physical exertion.

At the beginning of the study, the researchers noted that patients with higher complaints of angina pain were higher in rates of psychological stress and suffering from depression and anxiety, more use of antidepressant drugs, and higher a need to take cardiovascular drugs to relieve angina pain. This is all compared to patients without active chest pain. The researchers also noted that patients who reported feeling angina pectoris during a “myocardial perfusion imaging” test at the start of the medical follow-up had higher activity in the lower frontal lobe of the brain with a “PET scan”, and they had higher rates on the results of “evaluation.” Beck Depression Inventory Score.

Heart and brain

After two years of follow-up, the researchers noted that patients who complained more about angina pain had a higher average activity in the lower frontal lobe, compared to patients who reported a lower frequency of chest pain.

This prompted the researchers to say their summary: “It appears that the heart and the brain are closely related. The more feeling of angina pectoris is associated with increased activity of the lower frontal lobe. This may indicate that increased activity in the lower frontal lobe during psychological stress is independently associated with myocardial ischemia and angina pain. They added: “We were surprised by the strength of the relationship between the level of activity in this region of the brain and the complaints of angina pectoris. This is surprising because when we deal with angina in clinical settings, we usually do not consider psychological stress a major factor, and instead focus on blood flow in the heart.

Dr. Kasra Mozami, a co-author of the study, commented: “These results may change the model in which angina patients are evaluated, by refocusing clinical evaluation on Psychological Stress as one of the components of cardiac evaluation of angina cases.”

Angina pectoris … a “stable” type and a heart attack

> Angina pectoris is a description of a type of chest pain, and it results from poor blood flow to the heart muscle, and it is a symptom of coronary artery stenosis disease. In addition to the circumstance of exerting physical exertion, angina may occur when experiencing other conditions, such as emotional stress, exposure to cold temperatures, eating heavy meals and smoking.

It should be noted that the presence of “narrowing” in the course of any coronary artery to a “significant” degree causes the blood flow to decrease in the amount needed by the heart muscle. Upon physical exertion, the heart muscle’s need for more oxygen-bearing blood flow increases, and failure to achieve this (due to the narrowing of the arterial passage) leads the heart muscle to “whine” complaining of insufficient oxygen availability. The ‘moan’ of the heart muscle appears at that time in the form of ‘angina pectoris’.

In many cases, it is difficult to distinguish between angina pectoris pain and any other type of chest pain, such as indigestion, pain in the muscles and joints of the rib cage, pulmonary embolism, pneumonia, aortic valve stenosis, or panic attacks. Therefore, medical sources try to clarify what is meant by describing it: the feeling of pain or discomfort in the chest, similar to a feeling of pressure, squeezing, burning, or fullness. And perhaps with a feeling of pain in the arms, neck, jaw, shoulder, or back. Or a accompanying sensation of nausea, fatigue, shortness of breath, increased sweating or dizziness.

Because of the importance of the matter, it is worthwhile to evaluate these symptoms urgently by the doctor, in order to find out the cause of the pain, and whether the condition is Stable Angina, Unstable Angina, or Heart Attack.

And the medical view of these two types of angina pain has an aspect related to the difference in the feeling of pain, and the aspect related to the difference in the course of events within the narrowed coronary artery.

In general, in terms of “feeling” the pain, stable angina is characterized by the fact that the feeling of chest pain appears during physical exertion, such as walking, exercising or climbing stairs, and disappears upon complete physical rest or when taking angina medication that is placed under the tongue. Often the pain lasts for a short time, perhaps five minutes or less.

As for “unstable” angina, it is any type of angina pain that does not fit the description of “stable” angina. That is, the pain of angina pectoris that suddenly becomes a state of physical rest, or the pain of angina that is worse than its usual pattern. That is, for example, he appears with little physical exertion when he was previously not. Often “instability” is a sign of something more serious. When the pain lasts for longer than 10 or 15 minutes, and does not subside with physical rest or by taking an angina medicine that is placed under the tongue, it may indicate the possibility of a heart attack, and at that time it is worth taking the initiative to go to the hospital emergency department.

This is in terms of feeling pain, and on the one hand what actually happens inside the heart arteries in cases of “unstable” angina pain compared to “stable” angina, it is when the arterial narrowing increases dramatically in a short time, either due to a rapid increase in cholesterol and fat accumulation in The mass that narrows the artery, or due to the accumulation of platelets and the formation of a blood clot on the surface of the arterial stenosis, the state of narrowing in the artery becomes an “unstable condition”, at which time the blood flow decreases greatly and “the pain of unstable angina” occurs. Unless these cases are dealt with quickly, the condition of “unstable angina” may develop into a state of “heart attack” due to further arterial stenosis, reaching the point of complete blockage of the blood flow, and its access to the heart muscle, accordingly.

Interest in the effects of stress on the arteries of the heart

> When answering the question: When will I have angina? The American Heart Association says one reason for this is: experiencing a tantrum, psychological upset or emotional stress. Therefore, she recommends learning psychological relaxation behaviors and dealing with psychological tension in a positive and effective way to reduce its effects on the body.

Cardiologists from Mayo Clinic say: “The stress of emotional stress can increase the risk of angina and heart attacks. Too much stress and anger can also raise blood pressure. Hormonal influxes produced during stress can also lead to narrowing of the arteries and exacerbate angina.

In the March 2017 issue of the International Journal of Cardiology, researchers from Emory University published the results of their two-year follow-up on the effects of depression in patients with cardiac artery disease on the frequency of their chest pain. In the conclusion of their findings, they said: “Depression is associated with angina pectoris, regardless of the severity of the narrowing in heart disease. And patients with depression may not reap the appropriate benefit from treating those arteries Revascularization in terms of complaints of chest pain, compared to the benefit of their peers from heart patients who do not suffer from depression. This makes treating depression and alleviating its severity one of the successes of treating heart disease.

Dr. Nitsha Goldenberg, a cardiologist at Langwen University in New York, commented on the recent study, saying: “Previous studies have linked mental fatigue with decreased blood flow to the heart, which has been demonstrated by using Perfusion Nuclear Imaging. However, this new study is unique in that it looked at brain activity associated with mental stress, and was able to link this activity to angina. It shows that the heart and the brain are linked. ”


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