Psychiatry and Heart Disease E-Book

Michelle Riba

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 664

Veröffentlichungsjahr: 2012

Beschreibung

This unique book will help psychiatrists to understand better the risks of cardiovascular illness and cardiologists to appreciate possible pathophysiological links with psychiatric conditions.  It describes the common psychiatric conditions, their key features and how they may influence cardiovascular disease, outcomes, and quality of life. It also considers the cardiovascular complications that may arise as a result of mental illness. 

In an exciting, collaborative approach, psychiatrists and cardiologists combine their expertise throughout the book to provide guidance on the best way to manage such patients, considering the patient as a whole, not the individual conditions.

Leseprobe

Contents

Cover

Title Page

Copyright

List of Contributors

Foreword

Preface

References

Chapter 1: The Interaction Between Psychologic Distress and Biobehavioral Processes in Cardiovascular Disease

Introduction

Psychologic Distress and Cardiovascular Disease

Biologic Pathways Linking Psychologic Distress to Cardiovascular Risk

Conclusions and Future Directions

Summary Points

References

Chapter 2: Depression and Cardiovascular Diseases

Introduction

Review of Atherosclerosis and Coronary Disease

Epidemiology of Co-morbid Depression and Heart Disease

Possible Mechanisms to Explain the Connection Between Depression and CVD

Multiple Risk Factors in the Pathogenesis of Coronary Artery Disease

Summary Points

References

Chapter 3: Depression, Anxiety, Anger, and Heart Failure

Introduction

Diagnosis

Incidence and Prevalence

Course and Prognosis

Pathophysiology

Treatment

Conclusion

Summary Points

References

Chapter 4: Cardiac Surgery

Introduction

Pre-operative Period

Intra-operative Period

Postoperative Period

Heart Surgery for Congenital Heart Disease

Summary Points

References

Chapter 5: Cardiac Transplantation and Left Ventricular Assist Devices: Pre-Assessment and Post-Management

Introduction

Background

Pre-transplant Assessment

Ventricular Assist Devices

Post-transplant Psychiatric Care

Summary Points

References

Chapter 6: Psychiatric Aspects of Sudden Cardiac Arrest and Implantable Cardioverter-Defibrillators

Introduction

Sudden Cardiac Arrest

Psychiatric Contributions to SCA

Psychiatric Consequences of Resuscitation

ICD-Related Psychiatric Illness

Summary Points

References

Chapter 7: Pulmonary Arterial Hypertension: Psychosocial Implications and Treatment

Introduction

Biomedical Aspects

Emotional Adjustment of Adults with PAH

Psychiatric Treatment

Conclusion

Summary Points

References

Chapter 8: Distinguishing Cardiac from Psychologic Somatic Symptoms

Introduction

Interrelation with Psychiatric Disorders

Medically Unexplained Symptoms (MUS) – Models of Understanding

Conclusion

References

Chapter 9: Hypertrophic Cardiomopathy

Introduction

Brief review of Hypertrophic Cardiomyopathy

Psychiatric Morbidities

Quality of Life

Psychiatric Issues with Genetic Testing

Conclusion

References

Chapter 10: Bipolar Disorder and Reducing Risk for Cardiovascular Disease

Introduction

Descriptive overview of bipolar disorder

Common cardiovascular complications in persons with bipolar disorders

Underlying Mechanisms to Increased Cardiovascular Disease Risk

Medical Diagnosis

Pharmacologic Treatment

Non-pharmacologic and Behavioral Treatments

Acknowledgements

References

Chapter 11: Sleep and Cardiovascular Disease

Introduction

Prototypical Case of Insomnia

Prototypical Case of Sleep Disordered Breathing

Cardiovascular Hemodynamics During Normal Sleep

Disturbed Sleep Patterns: Insomnia

Diagnosis of Sleep-Related Breathing Disorders

IV. OSA and Coronary Risk Factors

OSA, Coronary Artery Disease, and Myocardial Infarction

OSA and Pulmonary Hypertension

OSA, CSA, and Heart Failure

Sleep Apnea and Arrhythmias

Summary Points

References

Chapter 12: Posttraumatic Stress Disorder and Heart Disease

Introduction

Description of Symptoms and Diagnostic Criteria

Prevalence and Course of PTSD in Cardiac Populations

Consequences of PTSD in Patients with Coronary Heart Disease

Predictors of PTSD in Cardiac Patients

Assessment of PTSD With Cardiac Catients

Pharmacologic Treatment of PTSD With Cardiac Patients

Psychologic Treatment of PTSD with Cardiac Patients

Summary points

References

Chapter 13: Cardiovascular Manifestations of Panic and Anxiety

Introduction

Pathophysiology of Emotion and Cardiac Function

Cardiac Symptoms and Cardiophobia

Co-morbidity and Differential Diagnosis

Treatment Considerations

The Implantable Cardioverter: Case Study of a Naturalistic Experiment

Summary

Summary Points

References

Chapter 14: Genetic Susceptibility and the Relationship between Cardiovascular Disease, Immunology, and Psychiatric Illness

Introduction

Review of Genetic Epidemiology

Evidence for Common Genetic Vulnerability to Depression and CAD

Potential Pathobiologic Pathways Predisposing to both Depression and Coronary Heart Disease

Serotonergic Pathway

The Genetics of Stress-Related Mechanisms as A Risk Factor for both Depression and CAD

Genetic Susceptibility and Molecular Relationships between Cardiovascular Disease, Immunology, and Psychiatric Illness

Summary Points

Acknowledgments

References

Chapter 15: Psychological Symptoms Associated with Cardiovascular Drugs; Cardiac Symptoms from Psychiatric Drugs; Drug Interactions,

Introduction

Cardiovascular Effects of Psychoactive Medications

Medication-Specific Concerns

Minimizing Cardiovascular Risks

Psychiatric Effects of Cardiovascular Medications

Drug Interactions Between Drugs Commonly Used in Psychiatry and Cardiology

Drug Interactions caused by Psychotropic Drugs

Drug Interactions caused by Cardiac Drugs

References

Chapter 16: Exercise and Depression

Introduction

Healthy and At-risk Populations

Pathophysiology of CVD in Individuals with Depression

Effects of Exercise and Depression on Cardiovascular Physiology

Structured Exercise for the Prevention and Treatment of Depression in Apparently Healthy Individuals

Patients with Cardiovascular Disease

Exercise Therapy in Cardiac Patients with Depression

Exercise Prescription for Depression

Salutary Effects of Exercise On Depression

Future directions

Conclusion

References

Chapter 17: Psychosocial Interventions: Meditation

Introduction

Conclusion

Summary Points

References

Chapter 18: Smoking Cessation and Substance Use Modification in Cardiovascular Disease

Co-occurrence of Smoking and Other Substance Use Disorders with CVD

Cigarette Smoking

Alcohol

Other Substances of Abuse

Treatment Interventions

Summary Points

References

Appendix A: Selected Screening Tools and Research Instruments

References

Appendix B: Berlin Questionnaire (for sleep apnea)

Index

This edition first published 2012 © 2012 by John Wiley & Sons, Ltd.

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Library of Congress Cataloging-in-Publication Data

Psychiatry and heart disease: the mind, brain, and heart / [edited by] Michelle Riba, Lawson Wulsin, Melvyn Rubenfire.

p.; cm.

Includes index.

ISBN 978-0-470-68580-8 (cloth)

1. Cardiovascular system–Diseases–Psychological aspects. 2. Medicine and psychology. I. Riba, Michelle B. II. Wulsin, Lawson R. III. Rubenfire, Melvyn.

[DNLM: 1. Cardiovascular Diseases–etiology. 2. Cardiovascular Diseases–psychology.

3. Mental Disorders–complications. WG 120]

RC669.P75 2011

616.1′0651–dc23

2011022873

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDF 9780470975121; Wiley Online Library 9780470975138; ePub 9781119978480; Mobi 9781119978497

First Impression 2012

List of Contributors

J. Todd Arnedt, PhD

Assistant Professor of Psychiatry and Neurology

Departments of Psychiatry and Neurology

University of Michigan

Ann Arbor, MI USA

Linda Baty, BSN, RN

Division of Cardiovascular Medicine

University of Michigan

Ann Arbor, MI USA

Jolene R. Bostwick, PharmD

Assistant Clinical Professor of Pharmacy

College of Pharmacy

University of Michigan

Ann Arbor, MI USA

Oliver Cameron, MD, PhD

Professor Emeritus of Psychiatry

Department of Psychiatry

University of Michigan

Ann Arbor, MI USA

Gregory W. Dalack, MD

Associate Professor of Psychiatry

Department of Psychiatry

University of Michigan

Ann Arbor, MI USA

Sharlene Day, MD

Assistant Professor of Internal Medicine

Division of Cardiovascular Medicine

University of Michigan

Ann Arbor, MI USA

D. Edward Deneke, MD

House Officer, Psychiatry

Department of Psychiatry

University of Michigan

Ann Arbor, MI USA

Leonard A. Doerfler, PhD

Professor of Psychology

Department of Psychology

Assumption College and

Department of Psychiatry

University of Massachusetts Medical School

Worcester, MA USA

David Bradley S. Dyke, MD

Assistant Professor of Internal Medicine

Division of Cardiovascular Medicine

University of Michigan

Ann Arbor, MI USA

Kim Eagle, MD

Professor of Internal Medicine

Division of Cardiovascular Medicine

University of Michigan

Ann Arbor, MI USA

Daniel Ehrmann, BS

Medical Student

University of Michigan

Ann Arbor, MI USA

Steven R. Erickson, PharmD

Associate Professor of Pharmacy

College of Pharmacy

University of Michigan

Ann Arbor, MI USA

Christopher M. Feindel, MD

Professor

Division of Cardiovascular Surgery, Peter Munk Cardiovascular Centre

Toronto General Hospital and the University of Toronto

Toronto, Ontario, Canada

Sandra M. Finkel, M.P.H.

Division of Cardiovascular Medicine

University of Michigan

Ann Arbor, MI USA

Barry A. Franklin, PhD

Director, Preventive Cardiology and Rehabilitation

Division of Cardiology

William Beaumont Hospital

Royal Oak, MI USA

Tamara Gay MD

Assistant Professor of Psychiatry

Department of Psychiatry

University of Michigan

Ann Arbor, MI USA

Nicholas D. Giardino, PhD

Assistant Professor of Psychiatry

Department of Psychiatry

University of Michigan

Ann Arbor, MI USA

Rachel Lipson Glick, MD

Clinical Professor

Department of Psychiatry

University of Michigan

Ann Arbor, MI USA

David E. Goodrich, EdD

Research Health Science Specialist

Department of Psychiatry

University of Michigan and VA Ann Arbor National Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC) and VA Health Services Research and Development Center for Clinical Management Research

Ann Arbor, MI USA

John S. Gottdiener, MD

Professor of Medicine

Division of Cardiology

University of Maryland School of Medicine

Baltimore, MD USA

Sanjaya Gupta, MD

Clinical Lecturer in Internal Medicine

Division of Cardiac Electrophysiology

University of Michigan

Ann Arbor, MI USA

Sally K. Guthrie, PharmD

Associate Professor of Pharmacy

College of Pharmacy

University of Michigan

Ann Arbor, MI USA

Elizabeth A. Jackson, M.D., M.P.H.

Assistant Professor of Internal Medicine

Division of Cardiovascular Medicine

University of Michigan

Ann Arbor, MI USA

Kevin B. Kerber, MD

Clinical Assistant Professor

Department of Psychiatry

University of Michigan

Ann Arbor, MI USA

Moira Kessler, MD

House Officer, Psychiatry

Northwestern McGaw/Feinberg School of Medicine

Chicago, IL USA

Amy M. Kilbourne, PhD, MPH

Department of Psychiatry

University of Michigan

and VA Ann Arbor National Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC) and VA Health Services Research and Development Center for Clinical Management Research

Ann Arbor, MI USA

Willem J. Kop, PhD

Tilburg University

Tilburg, Netherlands

Division of Cardiology

University of Maryland School of Medicine

Baltimore, MD USA

Ziad Kronfol, MD

Assistant Professor Emeritus of Psychiatry

Department of Psychiatry University of Michigan

Ann Arbor, MI USA and

Professor of Psychiatry

Weill Cornell Medical College in Qatar

Qatar

Dayna J. LePlatte, MD

House Officer, Psychiatry

Department of Psychiatry

University of Michigan Ann Arbor, MI USA

Marion E. McRae RN, NP, MScN

Nurse Practitioner – Cardiovascular Surgery

Toronto General Hospital and

Lawrence S. Bloomberg Faculty of Nursing

University of Toronto

Toronto, Ontario, Canada

John A. Paraskos, MD

Director of Diagnostic Cardiology

Department of Cardiovascular Medicine

University of Massachusetts Medical School

Worcester, MA USA

Frank Pelosi, MD

Associate Professor of Internal Medicine

Division of Cardiovascular Medicine

University of Michigan

Ann Arbor, MI USA

Bertram Pitt, MD

Professor Emeritus of Internal Medicine

Division of Cardiovascular Medicine

University of Michigan

Ann Arbor, MI USA

Divy Ravindranath, MD, MS

Clinical Assistant Professor of Psychiatry

Department of Psychiatry

University of Michigan

Ann Arbor, MI USA

Michelle B. Riba, MD, MS

Clinical Professor of Psychiatry

Department of Psychiatry

University of Michigan

Ann Arbor, MI USA

Elizabeth A.R. Robinson, PhD, MSW, MPH

Research Assistant Professor

Department of Psychiatry

University of Michigan

Ann Arbor, MI USA

Melvyn Rubenfire, MD

Professor of Internal Medicine

Director of Preventive Cardiology

University of Michigan

Ann Arbor, MI USA

Sara Saberi, MD

Clinical Lecturer of Internal Medicine

Division of Cardiovascular Medicine

University of Michigan

Ann Arbor, MI USA

Steven M. Schwartz, PhD

Adjunct Research Investigator

Department of Psychiatry

University of Michigan

Ann Arbor, MI USA

Michael J. Shea, MD

Professor of Internal Medicine

Division of Cardiovascular Medicine

University of Michigan

Ann Arbor, MI USA

Rima Styra, MD, MEd, FRCPC

Associate Professor of Psychiatry

Department of Psychiatry

University Health Network, Toronto General Hospital

Toronto, Ontario, Canada

Justin E. Trivax, MD

Chief, Interventional Cardiovascular Fellow

Division of Cardiovascular

Millennium Cardiology

Bingham Farms, MI USA

Thomas E. Vanhecke, MD

Department of Internal Medicine

Director, Cardiovascular Noninvasive Imaging

Genesys Regional Medical Center/Ascension Health

Grand Blanc, MI USA

Sandra Villafuerte, PhD

Research Investigator

Molecular and Behavioral Neuroscience Institute and

Department of Psychiatry

University of Michigan

Ann Arbor, MI USA

John M. Wryobeck, PhD

Assistant Professor

Department of Psychiatry

University of Toledo

Toledo, OH USA

Lawson Wulsin, MD

Professor of Psychiatry

Department of Psychiatry

University of Cincinnati

Cincinnati, OH USA

Foreword

Psychiatry and Heart Disease: The Mind, Brain, and Heart is an outstanding up-to-date reference connecting the heart and brain, from basic science mechanisms and insights to clinical associations that affect literally millions of patients in the United States and around the world. The book is wonderfully crafted, beginning with the association between risk factors and psychological distress, the relationship between depression and cardiovascular disease, the connection between psychiatric problems and congestive heart failure and post operative patients, and followed by important psychiatric issues that take place in patients undergoing cardiac transplantation after cardiac arrest, those harboring internal defibrillators, cardioverters and patients with severe diseases such as pulmonary hypertension. The second half of the book is equally insightful, focusing on items such as teasing out the differences between true cardiovascular symptoms and those caused by psychosocial somatic disorders, the management of the patient with bipolar disorder, the relationship of sleep with cardiovascular disease, and post traumatic stress syndrome. In addition, a very common problem, cardiovascular manifestation, of patients with panic and anxiety syndromes is covered in exquisite detail. Lastly, the authors have offered interesting discussions on genetic susceptibility, psychosocial symptoms from medications and psychiatric drugs, and the relationship with exercise, fitness and smoking.

For too long, we have failed to come together as disciplines to properly explore mind-heart interactions and their underpinnings. This book goes a long way to helping us delineate those interfaces in the modern era and anticipate where we must go with our science, education and treatment as we move forward.

Kim A. Eagle, MD

Albion Walter Hewlett Professorof Internal Medicine

Director, University of MichiganCardiovascular Center

Preface

Lawson Wulsin, Michelle B. Riba, MD, MS, Melvyn Rubenfire, MD, and Divy Ravindranath, MD, MS

This book aims to help bridge the gap in modern medicine that divides those who care for disorders of the mind from those who care for disorders of the heart. The current need for this book, and for other efforts bridging psychiatry and cardiology, follows from the profusion of research over the past two decades showing us how the cardiovascular system and psychological distress are each intimately linked to the central, peripheral, and autonomic nervous systems, the immune system, and limbic-hypothalamic-pituitary-adrenal-gonadotropic axis Until this profusion of studies of many kinds—epidemiologic, mechanistic, observational, and interventional—spelled out what has now become a roughly coherent if incomplete picture, it was all too easy for psychiatry and cardiology to ignore each other in clinical practice, at considerable cost to our patients and to our health care system, a cost that went mostly unrecognized on both sides of the gap.

Three large cardinal epidemiologic studies outline the context for the timing of this book: The Global Burden of Disease Study, the INTERHEART Study, and the finding by Colton et al that mental health has a more significant impact on life expectancy than smoking and obesity [Colton 2006]. In the early 1990's the World Health Organization's Global Burden of Disease Study redefined the burden of illness as the combination of years of life lost and years of life disabled by an illness, with a broad influence on global healthcare policy (Murray & Lopez, 1996). By this definition five of the top 10 most burdensome illnesses worldwide turned out to be mental illnesses. Major depression was the most disabling condition worldwide and heart disease the most lethal. And major depression, the fourth most burdensome illness at the time, is expected to climb to the second most burdensome illness worldwide by 2020, second only to heart disease (Murray & Lopez, 1996). This set of findings established the epidemiologic parity of depression and coronary disease as related public health problems worldwide.

In 2004 the INTERHEART Study, the largest global case-control study of risk factors for heart atttack, reported that in a sample of 24,767 people across 52 countries psychosocial risk factors, measured by self-report of stress and depression, predicted risk for myocardial infarction as strongly as smoking and more strongly than hypertension or obesity (Rosengren et al., 2004; Yusuf et al., 2004). The population attributable risks were: smoking 35.7%, psychosocial stress 32.5%, obesity 20%, hypertension 17%. This finding expanded the reach of smaller studies which have found that depression is as strong a predictor for the onset or progression of coronary heart disease as traditional coronary risk factors (Barth, Schumacher, & Herrmann-Lingen, 2004; Rugulies, 2002; van Melle et al., 2004; Wulsin & Singal, 2003). The INTERHEART Study also showed that a simple measure of psychosocial risk predicted poor outcomes consistently across genders, ages, populations, cultures, and healthcare systems (Sheps, Frasure-Smith, Freedland, & Carney, 2004). The concept of psychosocial risk can be operationalized in a simple but potent measure that captures the importance of stress and depression for the prediction of cardiovascular risk around the world. The authors concluded: “if this effect (of psychosocial stress) is truly causal, the importance of psychosocial factors is much more important than commonly recognized, and might contribute to a substantial proportion of acute myocardial infarction.”

In 2006 one of the more eye popping facts about mortality in the American population surfaced in publications estimating the years of life lost to specific chronic illnesses (Colton & Manderscheid, 2006). The impressive fact reported in this study of death rates in the chronically mentally ill in eight states compared to the general population was that chronic mental illness accounted for 26 years of life lost, about double the effect of smoking or obesity. How could chronic mental illness so dramatically shorten life? Suicide accounts for a small proportion of early deaths in the mentally ill. For the most part, mental illness shortens life by accelerating the development of cardiovascular risk factors early in life and by interfering with adequate preventive care, overlooking or ignoring cardiac symptoms, and leading to early cardiovascular events and deaths (Newcomer & Hennekens, 2007). The extensive overlap between the risk factors for heart disease and the risk factors for chronic mental illnesses (smoking, physical inactivity, social isolation, diabetes, inflammation, obesity, hypertension, sleep disturbance) has led to searches for shared genetic vulnerabilities, notably between major depression and coronary disease (McCaffery et al., 2006; Xian et al.) (See Chapter 13).

The inescapable conclusion we draw from these milemarking studies and the growing literature on the comorbidity of psychiatric and cardiac illness, much of which is cited in the chapters that follow, is that effective treatment of the cardiovascular system requires attention to the nervous system and psychosocial distress, and effective treatment of chronic mental illness often requires recognition of and attention to cardiovascular risks. The influence of this body of psychosomatic research on new directions in basic as well as clinical research, on clinical practice along the interface of psychiatry and cardiology, and on health care policy is only beginning to flower. This book marks the progress and charts paths for further growth.

The first section of this book applies a psychiatric lens to various cardiac conditions. The second section turns cardiology's lens on various psychiatric disorders. The final two sections address selected assessment and treatment issues. We hope this collection will foster further conversations between psychiatrists and cardiologists to improve the treatment of their shared patients. And we hope to add to the momentum of this bridging of psychiatry and cardiology through suggestions for promoting creative translational research at the basic science and clinical research levels.

The chapters authors were allowed to express a reasonable degree of bias toward and against the posit that depression, anxiety, and hostility are causal in atherosclerosis, acute events, and recurrent events. And we as editors tried to assure that the book is balanced.

References

1. Barth, J., Schumacher, M., & Herrmann-Lingen, C. (2004). Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosom Med, 66(6), 802–813.

2. Colton, C. W., & Manderscheid, R. W. (2006). Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis, 3(2), A42.

3. McCaffery, J. M., Frasure-Smith, N., Dube, M. P., Theroux, P., Rouleau, G. A., Duan, Q., et al. (2006). Common genetic vulnerability to depressive symptoms and coronary artery disease: a review and development of candidate genes related to inflammation and serotonin. Psychosom Med, 68(2), 187–200.

4. Murray, C., & Lopez, A. (1996). The Global Burden of Disease: Summary (Vol. Summary). Cambridge, Massachusetts: Harvard School of Public Health.

5. Newcomer, J. W., & Hennekens, C. H. (2007). Severe mental illness and risk of cardiovascular disease. JAMA, 298(15), 1794–1796.

6. Rosengren, A., Hawken, S., Ounpuu, S., Sliwa, K., Zubaid, M., Almahmeed, W. A., et al. (2004). Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet, 364(9438), 953–962.

7. Rugulies, R. (2002). Depression as a predictor of coronary heart disease. American Journal of Preventive Medicine, 23, 51–61.

8. Sheps, D. S., Frasure-Smith, N., Freedland, K. E., & Carney, R. M. (2004). The INTERHEART study: intersection between behavioral and general medicine. Psychosom Med, 66(6), 797–798.

9. van Melle, J. P., de Jonge, P., Spijkerman, T. A., Tijssen, J. G., Ormel, J., van Veldhuisen, D. J., et al. (2004). Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis. Psychosom Med, 66(6), 814–822.

10. Wulsin, L., & Singal, B. (2003). Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review. Psychosomatic Medicine, 65, 201–210.

11. Xian, H., Scherrer, J. F., Franz, C. E., McCaffery, J., Stein, P. K., Lyons, M. J., et al. Genetic vulnerability and phenotypic expression of depression and risk for ischemic heart disease in the Vietnam era twin study of aging. Psychosom Med, 72(4), 370–375.

12. Yusuf, S., Hawken, S., Ounpuu, S., Dans, T., Avezum, A., Lanas, F., et al. (2004). Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet, 364(9438), 937–952.

Chapter 1

The Interaction Between Psychologic Distress and Biobehavioral Processes in Cardiovascular Disease

Willem J. Kop1,2 and John S. Gottdiener2

1 Tilburg University, the Netherlands

2 University of Maryland School of Medicine, Baltimore, MD

Introduction

Myocardial infarction and sudden cardiac death can be triggered by emotional distress [1, 2]. The vulnerability for these acute coronary syndromes is primarily determined by the presence of coronary artery disease (CAD) and/or structural myocardial damage. Chronic psychiatric, psychologic and social conditions can influence the gradual progression of cardiovascular disease and may further enhance the likelihood or magnitude of emotion-related triggers of acute coronary syndromes, primarily in patients with underlying cardiovascular disease [3, 4].

The progression of early stages of cardiovascular disease to its clinical manifestation as acute coronary syndromes can in most cases be described in three phases: gradual subclinical disease progression, the vulnerable disease stage, and the presentation of acute coronary syndromes. Cardiac symptoms such as chest pain and other angina equivalents commonly, but not necessarily, emerge later in the disease process. We have previously proposed a three-category classification framework of cardiovascular psychologic risk factors based on the duration and temporal proximity to the occurrence of coronary syndromes (Fig. 1.1): (1) acute psychologic risk factors (e.g. outbursts of anger, mental activity, and acute distress) that may act as triggers of cardiac events within one hour; (2) episodic psychologic risk factors with a duration lasting from several weeks to two years (e.g. depression, exhaustion and episodes of distress related to job loss, divorce and exposure to extreme physical or mental adversity); and (3) chronic psychologic risk factors that promote the gradual progression of coronary artery disease (e.g. personality traits and adverse socioenvironmental circumstances). Chronic psychologic factors are associated with increased reactivity to acute stressors and also promote the risk of the development of episodic psychologic risk factors. Recent evidence also suggests that episodic risk factors such as depression are associated with an increased emotional and biologic response to acute stressors. As outlined in Fig. 1.1, these types of psychologic risk factors are associated with characteristic biologic and physiologic processes that play distinct roles at different disease stages. These psychologic risk factors often coincide and also need to be understood in the context of genetic background factors and traditional cardiovascular risk factors such as hypertension, dyslipidemia and diabetes mellitus.

Fig. 1.1 Conceptual model of the association between psychologic distress as related to acute coronary syndromes relative to underlying coronary artery disease severity