Ischemic, hemodynamic, and neurohormonal responses to mental and exercise stress - Experience from the psychophysiological investigations of Myocardial Ischemia Study (PIMI)
Ischemic, hemodynamic, and neurohormonal responses to mental and exercise stress - Experience from the psychophysiological investigations of Myocardial Ischemia Study (PIMI)
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DOI：
10.1161/01.cir.94.10.2402
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发表时间：
1996-11-15
期刊：
影响因子：
37.8
通讯作者：
Sheps, DS
中科院分区：
文献类型：
--
作者：
Goldberg, AD;Becker, LC;Sheps, DS
背景精神压力引起的心肌缺血，发生在较低的心率比在物理stress.Methods和结果的心肌缺血研究（PIMI）的心理生理学调查的病理生理学，评估了未经药物治疗的稳定性冠状动脉疾病和运动引起的缺血患者的生理和神经内分泌功能。通过放射性核素心室造影、心电图、血压和儿茶酚胺监测来测量对自行车运动、公开演讲和Stroop试验的血流动力学和神经激素反应。在精神压力下，心率、收缩压、心输出量和全身血管阻力增加，这些都与血浆肾上腺素增加相关。在运动过程中，全身血管阻力下降，血流动力学变化与肾上腺素水平之间没有关系。射血分数的下降在精神压力下比运动时更大。在精神应激时，射血分数的变化与体循环血管阻力的变化呈负相关。92%的患者在自行车运动期间和58%的患者在精神应激期间存在心肌缺血的证据。血浆肾上腺素和去甲肾上腺素的增加更大的缺血运动过程中发生，更大的增加，在全身血管阻力与缺血发生在精神stress.Conclusions精神应激引起的心肌缺血是与全身血管阻力显着增加，心率和心率-血压乘积相对较小的增加，运动引起的缺血相比。这些对精神压力的血流动力学反应可以通过肾上腺分泌肾上腺素来介导。所涉及的病理生理机制是重要的，在了解心肌缺血的病因，并可能在选择适当的抗缺血治疗。
Background The pathophysiology of mental stress-induced myocardial ischemia, which occurs at lower heart rates than during physical stress, is not well understood.Methods and Results The Psychophysiological Investigations of Myocardial Ischemia Study (PIMI) evaluated the physiological and neuroendocrine functioning in unmedicated patients with stable coronary artery disease and exercise-induced ischemia. Hemodynamic and neurohormonal responses to bicycle exercise, public speaking, and the Stroop test were measured by radionuclide ventriculography, ECG, and blood pressure and catecholamine monitoring. With mental stress, there were increases in heart rate, systolic blood pressure, cardiac output, and systemic vascular resistance that were correlated with increases in plasma epinephrine. During exercise, systemic vascular resistance fell, and there was no relationship between the hemodynamic changes and epinephrine levels. The fall in ejection fraction was greater with mental stress than exercise. During mental stress, the changes in ejection fraction were inversely correlated with the changes in systemic vascular resistance. Evidence for myocardial ischemia was present in 92% of patients during bicycle exercise and in 58% of patients during mental stress. Greater increases in plasma epinephrine and norepinephrine occurred with ischemia during exercise, and greater increases in systemic vascular resistance occurred with ischemia during mental stress.Conclusions Mental stress-induced myocardial ischemia is associated with a significant increase in systemic vascular resistance and a relatively minor increase in heart rate and rate-pressure product compared with ischemia induced by exercise. These hemodynamic responses to mental stress can be mediated by the adrenal secretion of epinephrine. The pathophysiological mechanisms involved are important in the understanding of the etiology of myocardial ischemia and perhaps in the selection of appropriate anti-ischemic therapy.