Mental stress and the cardiovascular system part II: Acute mental stress and cardiovascular disease

As in normal subjects, acute mental stress increases blood pressure measurements (sometimes to hypertensive levels) in subjects with cardiovascular disease. We found examples in the literature of acute mental stress increasing peripheral vascular resistance (as in isometric exercise) in patients with cardiovascular disease. We did not, however, find examples of acute mental stress decreasing peripheral vascular resistance (as in isotonic exercise) in subjects with cardiovascular disease.

Acute mental stress commonly increases heart rate in subjects with cardiovascular disease. Angina pectoris or other evidence of ischemia may accompany this increase in heart rate. Acute mental stress may alter cardiac electrical stability and lead to arrhythmias—some life-threatening.

Acute mental stress may provoke coronary artery vasoconstriction, reduce left ventricular ejection fraction, or induce or exacerbate left ventricular wall motion abnormalities in subjects with cardiovascular disease. In particular, anger among subjects with cardiovascular disease may leave them vulnerable to cardiac complications.