Showing papers by "Alan Rozanski published in 1990"

Mental stress as an acute trigger of ischemic left ventricular dysfunction and blood pressure elevation in coronary artery disease

Abstract: Acute mental stress may be a frequent trigger of transient myocardial ischemia, myocardial infarction and sudden cardiac death. In an experimental setting, the effect of mental stress on hemodynamics and left ventricular wall motion abnormalities (as detected by radionuclide ventriculography) was measured in 29 patients with exercise-induced myocardial ischemia. Seventy-five percent of the patients demonstrated mental stress-induced wall motion abnormalities. Patients frequently exhibited greater increases in peak systolic arterial pressure during mental stress than during exercise. Personally relevant mental stress is the most potent type of mental stress, both in terms of frequency and magnitude of ischemia. Most mental stress-induced ischemic episodes are clinically and electrocardiographically silent and occur at heart rates significantly lower than those seen during exercise. Both systolic and diastolic blood pressure increased during mental stress-induced ischemia, suggesting that increased myocardial oxygen demand plays a role in the pathophysiology of mental stress-induced transient ischemia. The significant magnitude and acute onset of this mental stress-induced blood pressure elevation may in some manner contribute to atherosclerotic plaque rupture. These findings may provide a pathophysiologic link to the epidemiologic association between mental stress and acute ischemic coronary events. A new ambulatory radionuclide detector that can concurrently monitor left ventricular ejection fraction and electrocardiographic ST-segment change may enhance the detection and evaluation of transient myocardial ischemia in ambulatory coronary patients.

Development of a Diary for Use with Ambulatory Monitoring of Mood, Activities, and Physiological Function

Abstract: This paper describes three studies developed and providing preliminary validation for a pocket-size, self-monitoring diary suitable for use infield research on relationships among psychological states, activities, and physiological events. In the first study, a principal-components analysis of the diary's mood and cognition scales yielded three factors—negative affect, engagement, and predictability. These showed moderate concordance across two samples. In the second study, diary self-ratings of events, moods, and cognitions were shown to be meaningfully correlated with ratings made by spouse observers, providing evidence of concurrent validity of the diary. In the third study, diary ratings made by the same subjects at home, at work, and in other locations differed from each other in expected ways, providing evidence for discriminative validity. Modifications to the diary are suggested, and possible uses and limitations of the instrument are discussed.

Applications of exercise radionuclide ventriculography in the clinical management of patients with coronary artery disease

Abstract: Exercise radionuclide ventriculography is commonly used in patients with coronary artery disease, for both diagnostic purposes and patient management decisions. Both applications are reviewed in this article. There has been much debate as to the diagnostic efficacy of this test. Four factors influence this determination: (1) patient referral biases, (2) the optimal criteria for test interpretation, (3) the technique for performing radionuclide ventriculography, and (4) technical factors. The role of each factor is discussed. After consideration of these factors, it is concluded that the diagnostic efficacy of exercise radionuclide ventriculography is high. This test is used as a criterion for many patient management decisions, such as the need for coronary artery bypass surgery or coronary angioplasty. This test is well suited for such purposes because of its ability to quantitate the magnitude of ischemia. In addition to left ventricular ejection fraction, the importance of the following five wall motion variables are reviewed relative to the information they provide regarding ischemic magnitude: (1) extent, (2) magnitude, (3) time to onset and (4) duration of exercise-induced wall motion abnormalities, and (5) the paradoxical reversal of rest abnormalities following exercise. It is shown how consideration of all potential variables enhances the clinical utility of this test.