Detection of exercise-induced myocardial ischemia from symptomatology experienced during testing in men and women

BACKGROUND AND OBJECTIVES

To examine the capacity of angina and related symptoms experienced during exercise-stress testing to detect the presence of ischemia, controlling for other clinical factors.

METHOD

The authors undertook a prospective study of 482 women and 425 men (mean age 58 years) undergoing exercise stress testing with myocardial perfusion imaging. One hundred forty-six women and 127 men reported chest pain, and of these, 25% of women and 66% of men had myocardial perfusion imaging evidence of ischemia during testing. The present article focuses on patients with chest pain during testing.

MAIN OUTCOME MEASURES

Outcome measures included chest pain localization, extension, intensity and quality, as well as the presence of various nonpain-related symptoms. Backward logistical regression analyses were performed separately on men and women who had experienced chest pain during testing.

RESULTS

Men who described their chest pain as 'heavy' were 4.6 times more likely to experience ischemia during testing (P=0.039) compared with other men, but this pain descriptor only slightly improved accuracy of prediction beyond that provided by control variables. In women, several symptoms added to the sensitivity of the prediction, such as a numb feeling in the face or neck region (OR 4.5; P=0.048), a numb feeling in the chest area (OR 14.6; P=0.003), muscle tension (OR 5.2; P=0.013), and chest pain that was described as hot or burning (OR 4.3; P=0.014).

CONCLUSIONS

A more refined evaluation of symptoms experienced during testing was particularly helpful in improving detection of ischemia in women, but not in men. Attention to these symptoms may favour timely diagnosis of myocardial perfusion defects in women.

The impact of cholesterol lowering on patients' mood

This study compared mood changes in 212 patients treated for hypercholesterolemia, as a function of their level of adherence to dietary recommendations. Assessments of mood (anxiety, depression, and hostility), measured by the Profile of Mood States, were obtained at baseline and 3-, 6-, and 12-month follow-up. Adherence to diet was categorized as low, medium, or high based on the Food Record Rating. Repeated-measures ANOVAs showed a significant decrease over time for anxiety, total cholesterol (TC), and low-density lipoproteins (LDL). A multiple regression was performed to determine if reductions in TC or LDL were associated with the anxiety decrease. The model for anxiety change was highly significant and included gender, baseline anxiety, number of stressful events, psychological stress, baseline level of adherence to diet, gender x adherence interaction, and change in TC x adherence interaction. In conclusion, cholesterol lowering did not negatively affect patients' moods. However, those who adhered poorly but nonetheless showed stable or reduced TC exhibited a greater decrease in anxiety.

Interpersonal behavior and resting blood pressure in college women: a daily monitoring study

Psychological factors have long been implicated in the development of hypertension. Most studies exploring this relationship employed questionnaires administered on only one occasion.

OBJECTIVE

to evaluate the relation between blood pressure and social behavior in the natural environment over an extended period of time.

METHOD

40 healthy young adult women at varying risk for hypertension were asked to record their behavior and affect following social interactions, three times a day for 32 days. Behaviors were representative of the interpersonal circumplex: dominance, submissiveness, agreeableness, and quarrelsomeness.

RESULTS

Casual blood pressure was significantly correlated with submissive behavior (r=.45, P<.05) and inversely correlated with agreeable behavior (r=-.35, P<.05). ANOVAs confirmed these findings and further revealed that offspring of hypertensives with relatively elevated blood pressure were most quarrelsome.

CONCLUSION

These results concur with the literature on the relationship between hostility and blood pressure but also suggest the importance of submissiveness in college women.

Cardiopulmonary baroreflex stimulation and blood pressure-related hypoalgesia

Results from both experimental animals and humans suggest that baroreflex stimulation may be involved in blood pressure-related hypoalgesia. However, most of this research, especially in the area of human experimentation, has focused on sinoaortic baroreceptors. Cardiopulmonary baroreflex stimulation may also be an important moderator of pain. Sixty-six healthy male undergraduates varying in risk for hypertension participated in an experimental protocol in which painful mechanical finger pressure was presented three times in a counterbalanced fashion. One pain stimulus was preceded by 6 min of supine rest, another by a period of rest interspersed with periodic Valsalva manoeuvres, and another by a period in which cardiopulmonary baroreceptors were stimulated by passive leg elevation. Significantly lower pain was reported by men with relatively elevated systolic blood pressure following leg elevation but not the other conditions. Cardiopulmonary baroreflex stimulation was documented by increased forearm blood flow and other data obtained via impedance cardiography. These results suggest that blood pressure related hypoalgesia may be at least partially related to cardiopulmonary baroreflex stimulation.

Risk for hypertension and diminished pain sensitivity in women: autonomic and daily correlates

Research suggests an association between risk for hypertension and decreased pain sensitivity. However, few studies have utilized non-behavioral indices of pain to corroborate subjective reports or sought to generalize these findings to women. Furthermore, it has not been established whether results obtained using well-controlled laboratory pain stimuli extend to naturalistic pain. In Study 1, 80 young adult women with (N = 40) and without (N = 40) a parental history of hypertension and with either normatively low or high resting systolic blood pressure (SBP) were exposed to two experimental pain stimuli, finger pressure and the cold pressor test. In addition to behavioral pain measures, respiratory sinus arrhythmia (RSA) reactions to pain were also assessed. Women with a parental history of hypertension and/or normatively high resting SBP experienced significantly less pain, as assessed by both behavioral and RSA measures. In Study 2, 37 of the participants from Study 1 monitored their behaviors, affect, and physical symptoms, three times a day for 32 days. Laboratory pain sensitivity was significantly correlated with daily reports of pain but not gastrointestinal symptoms. The present results confirm an association between risk for hypertension and hypoalgesia in women and suggest generalizability of this relationship to everyday life.

The effects of sodium loading on blood pressure and pain responses to the cold pressor test

Two cold pressor tests were administered to 18 healthy normotensive males on two occasions, after 2 weeks of dietary sodium loading and after 2 weeks of maintaining their normal diet. While the addition of an extra 10 g/day of sodium to the diet had no overall effect on resting cardiovascular activity, it produced significantly greater diastolic blood pressure and smaller heart rate responses to the pain stimuli. As well, consistent with the large animal literature indicating a relationship between high blood pressure and diminished pain sensitivity, pain ratings were found to be significantly lower during the sodium loaded testing session. The ratings were corroborated by evidence of lower skin conductance reactivity to the second cold pressor test in the sodium loaded condition. Information concerning an elevation of risk for hypertension, perhaps provided by baroreceptors, may lead to compensatory reactions with hypoalgesia as one effect.