Evidence exists that shows mental stress case 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.