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Chronic and Acute Psychological Risk Factors for Clinical Manifestations of Coronary Artery Disease

From the Uniformed Services University of the Health Sciences, Bethesda, MD.

View larger version (33K): [in a new window]   Fig. 1. Pathophysiological model of the relationships between chronic, episodic, and acute psychological risk factors for coronary syndromes. Acute psychological factors result in physiological responses, leading to cardiac effects (ie, electrical instability, increased cardiac demand, and decreased coronary supply). In vulnerable patients, these cardiac effects may have pathophysiological results, including arrhythmias, myocardial ischemia, thrombus formation, and plaque rupture. Episodic psychological factors have physiological correlates that are involved in the progression of severe coronary disease to acute coronary syndromes. Chronic psychological factors promote the onset of early atherosclerosis, especially in the setting of genetic vulnerability, adverse health behaviors, and other environmental risk factors. In addition, chronic psychological factors are related to increased frequency and response magnitude of acute psychological factors and promote the risk of developing episodic factors. BP = blood pressure; HR = heart rate. Modified from Krantz et al. (1).

View larger version (17K): [in a new window]   Fig. 2. Kaplan-Meier curves of exhausted (N = 43) and nonexhausted patients (N = 84). The exhausted group (solid line) had a less favorable clinical course after angioplasty compared with the nonexhausted group (dashed line) (p = .02). Reproduced from Kop et al. (23).

View larger version (57K): [in a new window]   Fig. 3. Left anterior descending coronary artery. Initial angiography (left), total occlusion after mental stress (middle), and revascularization after intracoronary administration of nitroglycerin and a calcium antagonist (right). Reproduced from Papademetriou et al. (52).