Historically, we have believed that mental stress might induce chest pain as a response to increased levels of catecholamines and consequently increased product (by 100%), just as it happens with physical stress.
This innovative study published in Circ Cardiovasc Imaging shows the activation of specific areas in the brain is independently associated with chest pain and other painful processes in the context of mental stress.
The inferior frontal cortex is an area in the brain involved in stress response. Higher activation of this area stimulated by acute mental stress might accelerate this response and the whole cascade of defense mechanisms. The first was well known, but there was no known correlation between this area in the brain and chest pain in coronary artery disease (CAD) patients.
The study included 148 patients with stable CAD exposed to mental stress and used a standardized series of tests while doing a high-resolution positron-emission CT scan to see what areas in the brain were activated and when.
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Every time the inferior frontal cortex increased its activity by 100% vs baseline levels, chest pain rose up to 14 points compared to resting values (Seattle Angina Questionnaire) which resulted significative (p=0.008).
Activation of other areas in the brain where pain is processed (thalamus, insula and amygdala) only accounted for, in best of cases, 40% of the total effect of the inferior frontal lobe activation on angina severity.
It also had an effect on chest pain at follow-up.
Conclusion
Inferior frontal love activation induced by mental stress is independently associated to angina symptom severity and frequency.
Original Title: Association Between Mental Stress- Induced Inferior Frontal Cortex Activation and Angina in Coronary Artery Disease.
Reference: Kasra Moazzami et al. Circ Cardiovasc Imaging. 2020;13:e010710. DOI: 10.1161/CIRCIMAGING.120.010710.
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