TRIGGERS OF MYOCARDIAL-ISCHEMIA DURING DAILY-LIFE IN PATIENTS WITH CORONARY-ARTERY DISEASE - PHYSICAL AND MENTAL ACTIVITIES, ANGER AND SMOKING

Objectives. This study assessed the potency of physical and mental act ivities and emotions (anger and anxiety) and smoking and other substan ce use as proximate triggers of ischemia in patients with coronary art ery disease during daily life. Background. Myocardial ischemia occurs during a wide variety of activities in patients with coronary artery d isease, but frequency and relative potency of physical and mental acti vities, smoking and use of caffeine and alcohol as triggers of ischemi a during daily life have not been established. Methods. Patients (n = 63) with coronary artery disease and evidence of out of hospital ische mia kept a validated structured diary of physical and mental activitie s and psychologic states while undergoing ambulatory electrocardiograp hic monitoring for 24 to 48 h. Results. Ischemia occurred most frequen tly during moderately intense physical and mental activities, Patients spent the largest proportion of time engaged in low intensity physica l and mental activities (p < 0.05), but the likelihood of ischemia was greatest during intense physical (p < 0.0001) and stressful mental ac tivities (p < 0.03). The percentage of time in ischemia was elevated a nd approximately equivalent for high intensity physical and high inten sity mental activities (5%) compared with 0.2% when patients were enga ged in low intensity activities, Strenuous physical activity (e.g., ef fortful walking, p < 0.05) and the experience of intense anger were po tent ischemic triggers, and heart rates at onset of ischemia increased with the intensity of physical and mental activity and with anger, Am ong smokers, ischemia was more than five times as likely when patients smoked than when they did not (during 27% vs, 5% of diary entries, p < 0.0001). Coffee and alcohol consumption were also related to ischemi a (p < 0.05), but this association disappeared after controlling for c oncurrent cigarette smoking, Conclusions. Triggers of ischemia in pati ents with coronary artery disease during daily life include not only s trenuous exercise, but also activities involving low levels of exertio n, such as anger and smoking, Mental activities appear to be as potent as physical activities in triggering daily life ischemia, Coffee and alcohol consumption are related to ischemia only by virtue of their as sociations with smoking.