Psychological Stress Associated With Chest Pain in People With Heart Disease

Study links brain’s reactivity to stress, an important consideration for angina treatment, say researchers
August 20, 2020 Updated: August 20, 2020

Psychological stress found in the inferior frontal lobe of the brain could have an association with chest pain in people with heart disease, according to research released in the journal Circulation: Cardiovascular Imaging.

The study was designed to examine how activity in the inferior frontal lobe of the brain affects the severity of angina.

Angina is chest pain or discomfort due to inadequate blood flow to the heart. Angina can occur because of coronary artery disease, but researchers don’t know much about the relationship between brain mechanisms when mental stress is present. This study was able to find a link between psychological factors and chest pain.

“Our study sought to understand the degree to which health care providers should incorporate stress and other psychological factors when evaluating and treating angina,” said lead investigator Amit J. Shah, M.D., M.S.C.R., assistant professor of epidemiology at Emory University’s Rollins School of Public Health in Atlanta. “Although brain imaging during a mental stress challenge is not a test that can be ordered in clinical settings, the study shows an important proof-of-concept that shows the brain’s reactivity to stress is an important consideration when considering angina treatment.”

For the study, a total of 148 people with coronary artery disease were followed from 2011 to 2014. The participants consisted of 69 percent men and 31 percent women, with an average age of 62. Each person was tested in a clinical setting for mentally stressful events while having brain and cardiac imaging.

All participants were assessed with three tests that were given over a two-week period. The tests included a mental stress test with brain imaging, a mental stress test with heart imaging, and an exercise or chemical stress test with heart imaging. During each test, participants were monitored for chest pain. Two years after the original testing, participants were given a questionnaire about chest pain and cardiovascular events such as diagnoses of heart disease.

Researchers found that brain activity in the inferior frontal lobe showed the strongest relationship with self-reported angina at baseline and again after a two year follow up. Participants who reported regular repeated angina symptoms had higher inferior frontal lobe activity in response to mental stress. Those who experienced angina during mental stress testing also had higher inferior frontal lobe activation compared to those who had no chest pain during the tests.

A significant association was also found between inferior frontal lobe activation during stress and the change in angina frequency at the two-year follow-up. Researchers believe this may suggest that brain-related changes might predict worsened future angina.

Emotional Regulation

The inferior frontal lobe of the brain is the area of the brain associated with emotional regulation and stress. Normally, physicians focus on the blood flow to the heart, but this study helps to outline the importance of the activity of the inferior frontal lobe when dealing with angina. Researchers found that the top three factors that explained angina frequency were all stress-related. These included brain activation, depressive symptoms, and post-traumatic stress disorder symptoms.

This study can help physicians with treatments and risk prevention for angina. With the rise in psychological stress in everyday life, health care providers need to understand the associations it may have on all health concerns.

Mat Lecompte is a freelance health and wellness journalist. This article was first published on Bel Marra Health.