INTERACTIONS BETWEEN MENTAL STRESS AND CORONARY ENDOTHELIAL DYSFUNCTION

Transient myocardial ischemia is a hallmark of coronary artery disease (CAD). It is clear that both physical and mental stress can precipita te ischemic episodes during daily life in CAD patients. Through studie s done in the cardiac catheterization laboratory, it is now evident th at mental stress can cause both an increase in myocardial oxygen deman d and a decrease in coronary blood supply by precipitating vasoconstri ction of atherosclerotic epicardial coronary arteries. This constricti on results from the lack of local endothelium-dependent vasodilation i n atherosclerotic vessels, leading to unopposed vasoconstriction secon dary to sympathetic activation. Therefore, vascular endothelium determ ines the vasomotor response to stress, and restoration of normal endot helial function in patients with coronary artery disease will be of pa ramount importance in the therapeutic armamentarium.