"Silent" Heart Damage Not So Quiet For Some Women With Heart Disease

November 11, 1998

DALLAS, Nov. 11 -- Women with heart disease feel more chest pain during mental stress than men, according to a study presented today at the American Heart Association's 71st Scientific Sessions.

As part of the National Institute of Health's Psychophysiologic Investigation of Myocardial Ischemia (PIMI) study, the researchers gave psychological stress tests to 26 women and 158 men, average age 63, all diagnosed with heart disease. Researchers tested the effects of psychological stress on ischemic heart disease -- a condition where the heart's demand for oxygen is greater than its supply. Most people with this condition tend to suffer "silent" ischemia, or reduced blood supply to the heart. The term "silent" means that many patients do not feel chest pain that is usually associated with ischemia.

"About half of all the individuals undergoing psychological stress have episodes of ischemia, but for the most part these episodes don't cause chest pain. We were curious why less than five percent actually get chest pain," says lead author David Sheps, M.D., professor of medicine and director of the division of cardiology at East Tennessee State University.

In response to stress, 78 individuals had ischemia, only nine of whom reported chest pain. Heart rates increased twice as much among participants who reported chest pain compared to those without chest pain. Over half of those who experienced chest pain were women.

"Individuals with chest pain were more likely to be women, have a history of high blood pressure and have larger heart rate responses than those without chest pain," he says.

Other studies have shown that people who have ischemia (both silent and not silent) associated with mental stress have a higher subsequent risk of heart damage, heart attack or even death, says Sheps.

Chest pain does not seem to predict a person's likelihood of heart attack or death because so few actually do suffer chest pain, says Sheps. Feeling the pain may actually be beneficial, he says, because these are the people who seek treatment and get the attention of their doctors.

Some studies suggest there are gender differences in the perception of pain during ischemia, Sheps says. "Women may process pain differently than men or have a lower threshold for pain."

Sheps also notes that people who experience chest pain also were more likely to have high blood pressure, high heart rates, and more symptoms of depression than those without chest pain. Sheps says that depression is often associated with greater awareness of symptoms of any illness and an increased response to stress.

Researchers measured ischemia by injecting mildly radioactive substances into the bloodstream that can be seen on an x-ray.

In the psychological stress test, individuals were asked to pretend a parent was in a nursing home and receiving poor care. They had to pretend to confront the nursing home director to complain about their parent's care.

During the stress tests, researchers measured blood pressure, heart rate, and several blood chemicals, while they monitored how the participants felt. The participants assessed their feelings by using a 0 to 10 scale to rank irritation/anger, tenseness and their interest in actually taking the test.

"We looked at the factors that might be particular or unusual in patients reporting pain," Sheps says. The results of studies like these could indicate a need for physicians to administer psychological stress tests as part of heart examinations in the future, he says.

By understanding the effects of stress on the heart, he says, physicians can better design treatments, perhaps including psychological training, to help people react differently to stress, he says.

Co-authors are Robert McMahon, Ph.D.; Lewis Becker, M.D.; Jerome Cohen M.D.; Kenneth Freedland, Ph.D.; Pater Kaufman, Ph.D.; Mark Ketterer, Ph.D.; Kathleen Light, Ph.D.; Carl Pepine, M.D.; James Raczynski, Ph.D.; and David Sheffield, Ph.D.
For more information Nov. 8-11
contact Cathy Yarbrough or Darcy Spitz
Dallas County Convention Center
(214) 853-8056

American Heart Association

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