(Circulation. 1997;96:1835-1842.)
© 1997 American Heart Association, Inc.
Articles |
Impact of Acute Mental Stress on Sympathetic Nerve Activity and Regional Blood Flow in Advanced Heart Failure
Implications for `Triggering' Adverse Cardiac Events
From the Division of Cardiology, Department of Medicine, and the Division of Nuclear Medicine and Biophysics, Department of Pharmacology, University of California, Los Angeles School of Medicine (C.K.H); and the Division of Nuclear Medicine and Biophysics, Albert-Ludwigs-University, School of Medicine, Freiburg, Germany (E.U.N.).
Correspondence to Holly R. Middlekauff, MD, UCLA Department of Medicine, Division of Cardiology, 47-123 CHS, 10833 Le Conte Ave, Los Angeles, CA 90095.
Background Evidence is accumulating that specific "triggers," such as intense psychological stress, may precipitate myocardial infarction and sudden death. Patients with advanced heart failure have increased resting sympathoexcitation, which has been directly related to increased mortality. The impact of triggers on sympathetic nerve activity and regional blood flow in heart failure has not been examined in patients with heart failure.
Methods and Results Twenty-seven patients with heart failure (NYHA functional class III or IV) and 26 age-matched normal control subjects were studied. Muscle sympathetic nerve activity, heart rate, mean arterial pressure, forearm blood flow, and renal blood flow were measured during mental stress testing with mental arithmetic and Stroop color word test. Patients with heart failure had elevated levels of resting muscle sympathetic nerve activity and heart rate. Mental stress significantly increased muscle sympathetic nerve activity and heart rate in both patients with heart failure and control subjects, although the magnitude of increases tended to be blunted in patients with heart failure. Nevertheless, absolute levels of sympathetic activity in patients with heart failure remained significantly higher than levels in control subjects during mental stress. The decrease in renal blood flow in patients with heart failure was similar to that of control subjects, despite greater resting renal vasoconstriction. The increase in forearm blood flow during mental stress testing in patients with heart failure was blunted compared with that of control subjects.
Conclusions Patients with heart failure do not have augmented muscle sympathetic nerve activity responses to mental stress, despite elevated resting levels of sympathetic activity, but they do have markedly higher absolute levels of sympathetic nerve activity during mental stress as well as at rest.
Key Words: death, sudden • kidney • heart failure • nervous system, autonomic • stress
This article has been cited by other articles:
 |
|
 |
|
  J. R. Carter and C. A. Ray Sympathetic neural responses to mental stress: responders, nonresponders and sex differences Am J Physiol Heart Circ Physiol, March 1, 2009; 296(3): H847 - H853. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. E. Negrao and H. R. Middlekauff Exercise training in heart failure: reduction in angiotensin II, sympathetic nerve activity, and baroreflex control J Appl Physiol, March 1, 2008; 104(3): 577 - 578. [Full Text] [PDF]
|
|
|
|
 |
|
 H.-J. Lee, Y. Chae, H.-J. Park, D.-H. Hahm, K. An, and H. Lee Turo (Qi Dance) Training Attenuates Psychological Symptoms and Sympathetic Activation Induced by Mental Stress in Healthy Women Evid. Based Complement. Altern. Med., November 1, 2007; (2007) nem120v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. D. Holmes, D. S. Krantz, W. J. Kop, A. Del Negro, P. Karasik, and J. S. Gottdiener Mental Stress Hemodynamic Responses and Myocardial Ischemia: Does Left Ventricular Dysfunction Alter These Relationships? Psychosom Med, July 1, 2007; 69(6): 495 - 500. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Hayashi, N. Someya, M. Y. Endo, A. Miura, and Y. Fukuba Vasoconstriction and blood flow responses in visceral arteries to mental task in humans Exp Physiol, January 1, 2006; 91(1): 215 - 220. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. C. Santos, M. J. N. N. Alves, M. U. P. B. Rondon, A. C. P. Barretto, H. R. Middlekauff, and C. E. Negrao Sympathetic activation restrains endothelium-mediated muscle vasodilatation in heart failure patients Am J Physiol Heart Circ Physiol, August 1, 2005; 289(2): H593 - H599. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. MONTEBUGNOLI, D. SERVIDIO, R. A. MIATON, and C. PRATI Heart rate variability: A sensitive parameter for detecting abnormal cardiocirculatory changes during a stressful dental procedure J Am Dent Assoc, December 1, 2004; 135(12): 1718 - 1723. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. N. Dzeka and J. M. O. Arnold Prostaglandin modulation of venoconstriction to physiological stress in normals and heart failure patients Am J Physiol Heart Circ Physiol, March 1, 2003; 284(3): H790 - H797. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. MONTEBUGNOLI and C. PRATI Circulatory dynamics during dental extractions in normal, cardiac and transplant patients J Am Dent Assoc, April 1, 2002; 133(4): 468 - 472. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Elam and V. Macefield Multiple firing of single muscle vasoconstrictor neurons during cardiac dysrhythmias in human heart failure J Appl Physiol, August 1, 2001; 91(2): 717 - 724. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K J Paavonen, H Swan, K Piippo, L Hokkanen, P Laitinen, M Viitasalo, L Toivonen, and K Kontula Response of the QT interval to mental and physical stress in types LQT1 and LQT2 of the long QT syndrome Heart, July 1, 2001; 86(1): 39 - 44. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. R. Middlekauff, J. L. Yu, and K. Hui Acupuncture effects on reflex responses to mental stress in humans Am J Physiol Regulatory Integrative Comp Physiol, May 1, 2001; 280(5): R1462 - R1468. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Kamiya, S. Iwase, D. Michikami, Q. Fu, and T. Mano Head-down bed rest alters sympathetic and cardiovascular responses to mental stress Am J Physiol Regulatory Integrative Comp Physiol, August 1, 2000; 279(2): R440 - R447. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. E. Negrao, M. A. Hamilton, G. C. Fonarow, A. Hage, J. D. Moriguchi, and H. R. Middlekauff Impaired endothelium-mediated vasodilation is not the principal cause of vasoconstriction in heart failure Am J Physiol Heart Circ Physiol, January 1, 2000; 278(1): H168 - H174. [Abstract] [Full Text] [PDF]
|
|