Triggers of myocardial ischemia during daily life in patients with coronary artery disease: Physical and mental activities, anger and smoking
Triggers of myocardial ischemia during daily life in patients with coronary artery disease: Physical and mental activities, anger and smoking
复制标题
DOI：
10.1016/0735-1097(95)00510-2
复制
发表时间：
1996-03-01
影响因子：
24
通讯作者：
Rozanski, A
中科院分区：
文献类型：
--
作者：
Gabbay, FH;Krantz, DS;Rozanski, A
目标。这项研究评估了日常生活中冠状动脉疾病患者的身体和精神活动以及情绪（愤怒和焦虑）以及吸烟和其他物质使用作为缺血的直接触发因素的效力。背景。冠状动脉疾病患者在各种活动中都会发生心肌缺血，但日常生活中体力和精神活动、吸烟以及使用咖啡因和酒精作为缺血触发因素的频率和相对效力尚未确定。方法。患有冠状动脉疾病和院外缺血证据的患者 (n = 63) 在接受 24 至 48 小时的动态心电图监测时，保留了经过验证的身体和精神活动以及心理状态的结构化日记。结果。缺血最常发生在中等强度的体力和脑力活动期间，患者从事低强度体力和脑力活动的时间比例最大（p < 0.05），但在剧烈体力活动（p < 0.0001）和应激性脑力活动（p < 0.03）期间发生缺血的可能性最大。与进行低强度活动时的 0.2% 相比，高强度体力和高强度脑力活动的缺血时间百分比有所增加，且大致相当（5%）。剧烈体力活动（例如，费力行走，p < 0.05）和强烈愤怒的经历是有效的缺血触发因素，缺血发作时的心率随着体力和脑力活动强度以及愤怒的增加而增加。在吸烟者中，缺血的可能性是其五倍以上患者吸烟时与不吸烟时相比（27% vs. 5% 的日记条目，p < 0.0001）。咖啡和饮酒也与缺血有关（p < 0.05），但在控制同时吸烟后这种关联消失了。结论。冠状动脉疾病患者在日常生活中引发缺血的诱因不仅包括剧烈运动，还包括低强度活动，例如愤怒和吸烟。精神活动似乎与体力活动一样有效地引发日常生活中的缺血。咖啡和饮酒与缺血的关系只是因为它们与吸烟有关。
Objectives. This study assessed the potency of physical and mental activities and emotions (anger and anxiety) and smoking and other substance use as proximate triggers of ischemia in patients with coronary artery disease during daily life.Background. Myocardial ischemia occurs during a wide variety of activities in patients with coronary artery disease, but frequency and relative potency of physical and mental activities, smoking and use of caffeine and alcohol as triggers of ischemia during daily life have not been established.Methods. Patients (n = 63) with coronary artery disease and evidence of out of hospital ischemia kept a validated structured diary of physical and mental activities and psychologic states while undergoing ambulatory electrocardiographic monitoring for 24 to 48 h.Results. Ischemia occurred most frequently during moderately intense physical and mental activities, Patients spent the largest proportion of time engaged in low intensity physical and mental activities (p < 0.05), but the likelihood of ischemia was greatest during intense physical (p < 0.0001) and stressful mental activities (p < 0.03). The percentage of time in ischemia was elevated and approximately equivalent for high intensity physical and high intensity mental activities (5%) compared with 0.2% when patients were engaged in low intensity activities, Strenuous physical activity (e.g., effortful walking, p < 0.05) and the experience of intense anger were potent ischemic triggers, and heart rates at onset of ischemia increased with the intensity of physical and mental activity and with anger, Among smokers, ischemia was more than five times as likely when patients smoked than when they did not (during 27% vs, 5% of diary entries, p < 0.0001). Coffee and alcohol consumption were also related to ischemia (p < 0.05), but this association disappeared after controlling for concurrent cigarette smoking,Conclusions. Triggers of ischemia in patients with coronary artery disease during daily life include not only strenuous exercise, but also activities involving low levels of exertion, such as anger and smoking, Mental activities appear to be as potent as physical activities in triggering daily life ischemia, Coffee and alcohol consumption are related to ischemia only by virtue of their associations with smoking.