Cardiac coping style, heartbeat detection, and the interpretation of cardiac events

OBJECTIVES

Vigilance to, and avoidance of, cardiac sensations and symptoms were explored in three studies.

DESIGN AND METHODS

In the first study, a self-report measure of cardiac vigilance and cardiac avoidance, the Cardiac Coping Inventory (CCI), was administered to 453 students, and its factor structure, internal consistency, and test-retest reliability were established. In the second, 31 undergraduates completed the CCI, and their cardioceptive sensitivity was measured on a heartbeat detection task. In a third study of 91 patients with suspected myocardial infarction, the role of coping styles in symptom interpretations was analysed.

RESULTS

Cardiac avoidance and vigilance were independent of general symptom reporting tendencies. Cardiac vigilance was negatively correlated with heartbeat detection. Among the patients, delay in seeking treatment was predicted by the perceived importance of chest pain, which was influenced by the intensity of chest pain and cardiac vigilance.

CONCLUSIONS

Although individuals high in cardiac vigilance do not seem to be good detectors of their heartbeats in the laboratory, they appear to attach importance to heart symptoms in real life, resulting in a health-protective behaviour.

Cardiovascular reactivity to mental stress in the Stockholm Female Coronary Risk Study

OBJECTIVE

This study evaluated the ability of mental stress testing to discriminate between women with and without CHD, and among women with different disease manifestations, taking into account history of hypertension and beta-blocker use.

METHODS

Analyses were based on data from a community-based case-control study of women aged 65 years or younger. The study group consisted of 292 women who were hospitalized for an acute event of CHD, either AMI or unstable AP in Stockholm between 1991 and 1994. Controls were matched to cases by age and catchment area. Cardiovascular reactivity and emotional response to an anagram task solved under time pressure were measured 3 to 6 months after hospitalization.

RESULTS

Patients reacted with smaller increases in heart rate (4 bpm) than their controls (7 bpm). Results for the rate-pressure product were similar. Cardiovascular reactions did not distinguish patients with AP from those with AMI. History of hypertension (present in 50% of patients and 11% of controls) was related to enhanced diastolic blood pressure reactivity. Patients on beta-blockers (66%) had lower heart-rate levels throughout testing, but did not differ in their cardiovascular stress reactions when compared with the remaining participants.

CONCLUSIONS

Women with heart disease have somewhat lower heart-rate responses to stress than healthy age-matched controls. History of hypertension is related to enhanced diastolic blood pressure reactivity to mental stress in both patients and controls.