Another one from Mattu’s Feb review. This article compares psychological stress to physical stress to detect effects on perfusion of the heart. Interestingly mental stress causes ischemia where physical stress does not seem to.

There has always been an intuitive relationship between psychological stress and myocardial ischemia. Bernard Lown, a famous cardiologist, said in EVERY MI patient he had he would find a recent large social stressor in the patient. Of course plenty of hindsight bias occurs here.

Either way, if nothing else with this article remember that emotional stress causing chest pain COUNTS AS exertional ischemic symptoms. The fight with the boyfriend or girlfriend does not allow for blaming the pain on “anxiety.” And perhaps the real stress test in our Chest Pain Center is the 20 hours of sleep deprivation coupled with exposure to yelling, retching and dying that our patients must undergo to make it upstairs for a nice quiet little stroll on the treadmill.