Mental stress test is an effective inducer of vasospastic angina pectoris:comparison with cold pressor, hyperventilation and master two-step exercise test

Background: Cold presser, hyperventilation and exercise stress tests were u sually used for inducing an angina attack in patients with vasospastic angi na pectoris. We induced vasospastic angina attack using the mental calculat ion stress test, and compared the results with those using other stress tes ts. Subjects and methods: Subjects were 29 patients with vasospastic angina pectoris. Their ages were 60.8+/-8.4 years. Coronary vasospasm was induced by an acetylcholine infusion test during coronary angiography. The mental stress test was performed as follows; after memorizing six digits numbers, they repeated these numbers in reverse for 5 min, and performed serial subt raction of 17 from 1000 for 5 min. Blood pressure, heart rate and ECG were recorded every 1-5 min during the mental stress test. The serum concentrati ons of epinephrine and norepinephrine were measured before and during the m ental stress test. We compared these results with those obtained using cold presser, hyperventilation and the Master two-step exercise stress test. Re sults: (1) Eight of the 29 patients (28%) showed ischemic ST-T change, whic h was caused by the mental stress test. (2) The increase in norepinephrine was greater in patients with an ST-T change than without an ST-T change (0. 11+/-0.06 vs. 0.04+/-0.04 ng/ml, P<0.01). (3) The incidence of the ST-T cha nge caused by the mental stress test (28%) was similar to the cold presser test (27%) and greater than that caused by the hyperventilation test (13%). The incidence of ST-T change caused by the Master two-step test was 55%. C onclusions: The mental stress test is an effective inducer of vasospastic a ngina attack, and attack may be induced by neurohumoral vasoconstrictive re flex and/or increased left ventricular afterload. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.