Relation between ventricular arrhythmias and psychological profile

Behavioral Factors, Life Changes, and the Development of Vital Exhaustion and Depression in Myocardial Infarction Patients

Epidemiological studies on psychosocial precursors of myocardial infarction (MI) in middle-aged subjects suggest that in the year prior to MI, psychological phenomena of 'vital exhaustion and depression' may be an equally important diagnostic measure as manifestations of chest pain, and other cardiac symptoms. A self-administered psychological survey the 'Maastricht Questionnaire' (MQ) was constructed in order to measure the prodromal phenomena of 'vital exhaustion and depression'.

In this paper, several retrospective and longitudinal studies on MI patients and controls are commented on in which the MQ was employed. Since these studies as such cannot explain why an association exists, a retrospective investigation in a sample of 136 healthy middle-aged men was undertaken. In this study, the interrelationships between the Type A coronary-prone behavior pattern, exposure to stressful life changes over a two year period, and the association with the MQ were explored. Coronary-prone behavior was assessed through the Jenkins Activity Survey (JAS), exposure to stressful life changes through our Middle Adulthood Life Changes Questionnaire (MALC), which is described in full.

It is demonstrated that manifestations of 'vital exhaustion and depression' are associated in particular with life changes in the Home & Social domain on the MALC, and with Type A coronary-prone behavior. The latter is associated also in particular with life changes connoting work involvement and conflict proneness in the Work & Career domain on the MALC.

The extended MALC, now covering the whole human life span, and the MQ are current employed in a case-control study on MI patients, neighborhood and hospital controls in order to explore further the ontogenetic factors that may be conducive to the development of 'vital exhaustion and depression', and subsequent MI. Methodological considerations for extending the MALC are discussed, together with an illustrative case history on a MI patient from this study.

Relation between arrhythmic sensations, cardiac arrhythmias and psychological profile

The relation between arrhythmic sensations and objective findings of ectopic arrhythmic activity was studied in 150 middle-aged men. Objective arrhythmias were studied by 24-hour Holter monitoring and subjective symptoms assessed by a questionnaire and a dairy protocol during the ECG recording. Psychological characteristics were described by means of a personality inventory, the Emotions Profile Index. No direct relationship was found between subjective symptoms and objective findings of cardiac arrhythmias. Those men, however, who complained of arrhythmic sensations but had no clinically important arrhythmias exhibited a few specific characteristics. They had no signs of organic heart disease and appeared less trustful and more aggressive than those with arrhythmias.

Anxiety and coronary heart disease: a synthesis of epidemiological, psychological, and experimental evidence

The purpose of this review is to examine the epidemiological, psychological, and experimental evidence for an association between anxiety and coronary heart disease (CHD). Papers published during the years 1980-1996 on anxiety and CHD and relevant publications from earlier years were selected for this review. Epidemiologic evidence suggests that anxiety may be a risk factor for the development of CHD. Chronic anxiety may increase the risk of CHD by: (a) influencing health behaviors (e.g. smoking); (b) promoting atherogenesis (e.g. via increased risk of hypertension); and (c) triggering fatal coronary events, either through arrhythmia, plaque rupture, coronary vasospasm, or thrombosis. Electrophysiologic evidence is particularly compelling: anxiety appears to be associated with abnormal cardiac autonomic control, which may indicate increased risk of fatal ventricular arrhythmias. The strength, consistency, and dose-response gradient of the association between anxiety and CHD, together with the biologic plausibility of the experimental evidence, suggest that anxiety may contribute to risk of CHD and that the relationship warrants further investigation.

Palpitations and lifestyle: impact of depression and self-rated health. The Nordland Health Study

On the basis of a questionnaire in a population study in the county of Nordland, Norway, the prevalence of palpitations and its associations to some lifestyle factors, depression and self-rated health were analysed. All the 10,497 residents aged 40 to 42 years were invited to participate, 82% attended, 87% of the attenders returned a questionnaire by mail, and 6436 subjects were included in this report. The prevalence of palpitations was 15% in men and 25% in women. Palpitations were significantly associated with coffee consumption, smoking, alcohol intoxication, physical inactivity, depression and poor self-rated health in the univariate analyses. In a logistic regression analysis, the relations between palpitations and lifestyle were weakened. Significant predictors for palpitations were depression and poor self-rated health in both sexes, in addition to heavy coffee drinking and physical inactivity in men and alcohol intoxication in women. In conclusion, palpitations were more firmly linked to depression and self-evaluated health than to lifestyle.

Ventricular tachycardia and psychiatric depression in patients with coronary artery disease

PURPOSE

The purpose of this study was to examine the relationship between psychiatric depression and ventricular arrhythmias in patients with coronary artery disease (CAD). The hypothesis was that depressed patients with CAD would have a higher prevalence of ventricular tachycardia (VT) than nondepressed patients with CAD.

PATIENTS AND METHODS

One hundred three patients who were found to have significant CAD by elective diagnostic cardiac catheterization were administered a standardized psychiatric interview and underwent 24-hour Holter monitoring.

RESULTS

Twenty-one patients (20%) met the criteria for either major or minor depression. There were no significant differences between depressed and nondepressed patients with CAD in severity of CAD or in ventricular function. Five (23.8%) of the depressed patients and three (3.7%) of the nondepressed patients exhibited episodes of VT during 24 hours of Holter monitoring (p < 0.008). This difference remained significant even after controlling for relevant covariates.

CONCLUSIONS

We conclude that there is a higher prevalence of VT among patients with CAD and depression than among those CAD patients without depression. This may help to explain the increased risk for cardiac mortality in depressed patients with CAD.

Relation of psychosocial and stress reactivity variables to ventricular arrhythmias in the Cardiac Arrhythmia Pilot Study (CAPS)

Both animal and human data implicate psychosocial distress and cardiovascular reactivity in response to challenge in the etiology of sudden cardiac death. In this study, the relation of these biobehaviorial factors to frequency of ventricular premature complexes, a predictor of sudden death was investigated. The study population was made up of patients enrolled in the National Heart, Lung, and Blood Institute's Cardiac Arrhythmia Pilot Study (CAPS). Ventricular premature complexes (VPCs) were assessed by multiple, 24-hour ambulatory electrocardiographic recordings. Patients completed trait psychosocial measures assessed at baseline and state psychosocial measures assessed periodically during a 1-year follow-up period. Psychosocial measures included self-reports of depression, anxiety, anger and type A behavior pattern. A competitive challenge using a video game was used as a stressor to elicit cardiovascular reactivity and was administered at baseline and during follow-up sessions. Cardiovascular reactivity was defined as peak level during stressor exposure minus the mean of resting levels for systolic and diastolic blood pressure and pulse rate. Results indicated that biobehavioral factors were not associated with diurnal VPC rates. Furthermore, biobehavioral factors did not predict response to antiarrhythmic therapy. Based upon the results of this study, it is speculated that the established relation between behavioral factors and sudden death may not be mediated by VPC rates.

Psychological distress as a predictor of ventricular arrhythmias in a post-myocardial infarction population

A prospective study examining the relationship between psychological distress and ventricular ectopy was conducted with 125 post-myocardial infarction patients equipped with a transtelephonic ECG monitor. Subjects were subsequently grouped according to the occurrence (n = 59) or nonoccurrence (n = 65) of ventricular arrhythmias over a 1-year period. Results indicated a direct relationship between self-reported distress levels and occurrence of ectopic beats. This relationship was unaltered by adjusting simultaneously for known predictors of arrhythmias, including cardiac risk, age, and the prescription of beta-blocker agents. Thus this study represents an initial demonstration in a post-myocardial infarction population that psychosocial factors have prognostic significance for arrhythmias and, presumably, sudden death.