Mental stress can trigger myocardial infarction, reversible cardiomyopathy, and sudden death in susceptible individuals.
Metaanalysis have shown in that individuals with coronary heart disease mental stress in a controlled environment such as public speaking, mental arithmetic, anger recall, was associated with inducing myocardial ischemia in 32% of patients either with transient regional wall motion abnormalitiess on echocardiography, ST segment deviation on electrocardiogram, or reversible defects on myocardial perfusion imaging with single photon admission computed tomography.
Another metaanalysis showed that mental stress induced myocardial ischemia in patients with coronary artery disease was associated with increased risk of recurrent cardiac events and mortality compared with individuals with coronary heart disease but without mental stress induced myocardial ischemia, with absolute rates of these outcomes of 34 verses 14%, respectively.
In approximately 17% of patients with stable coronary artery disease, acute mental distress can trigger myocardial ischemia detected by myocardial perfusion imaging.
Myocardial ischemia provoked by mental stress is usually asymptomatic, occurs at a lower hemodynamic workload, and can occur in patients who do not have a positive conventional stress test.
Mental stress induced ischemia may be associated with abnormal vasomotion, psychological conditions, and platelet reactivity.
Patients who experience a major cardiovascular event more commonly have depression or anxiety: and those with depression and anxiety have approximately 32% higher relative risk of a major cardiovascular event then those with the diagnosis of only one mental health condition.
People diagnosed with depression show increased amygdala – to – cortex activity on brain imaging, a sign of stress related neural activity.
These patients have reduced heart rate variability and higher blood levels of C reactive, protein, indicators of increased autonomic activity and systemic inflammation.
When the brains stress circuits are overactive, they can chronically trigger their bodies, fight or fight system, leading to increased heart rate, blood pressure, and chronic inflammation, which overtime leads to damaged blood vessels and accelerated heart disease.
Depression or anxiety, accelerates the development of cardiovascular risk factors, namely, hypertension, hyperlipidemia, and type 2 diabetes, especially in young women.