AWARENESS AND CONTROL OF THE CARDIOVASCULAR-RESPONSE TO STRESS AMONG MEN WITH AND WITHOUT AN ACUTE MYOCARDIAL-INFARCTION

Objective: To compare males who had sustained an acute myocardial infa rction with healthy controls in awareness and control of their cardiov ascular responses to laboratory stressors as well as their ability to relax. Design: Patients and volunteer controls were recruited to parti cipate in a case control comparative study using a structured protocol . Setting: Patients were recruited from the Ottawa General Hospital. C ontrols came from the Ottawa-Carleton region. All participants were st udied in the authors' laboratory at the hospital. Patients: Thirty-two men who had sustained an acute myocardial infarction within two years and 39 healthy male controls are reported. Forty-one patients refused participation and 47 were excluded. Interventions: All participants c ompleted a self-administered questionnaire and underwent a structured 1 h laboratory session that included exposure to psychological and phy sical (cold pressor) stress alternating with attempts to relax. During the laboratory session, cardiovascular reactivity was monitored nonin vasively. Main Results: Compared with controls, patients presented wit h higher levels of cardiovascular reactivity on exposure to stress, pr imarily in their vasoconstrictive response. More cases demonstrated an increase in systemic vascular resistance while attempting to relax; t hey reported feeling relaxed immediately following exposure to stress. Conclusion: The discordance between the subjective feeling of relaxat ion and the actual physiological response indicates, in postinfarction male patients, an impaired ability to monitor and regulate the stress response.