A recent study conducted by researchers at the Duke Heart
Center was published in the Journal of the American College of Cardiology. This
study explored mental stress and the physiological responses of patients with
stable heart disease. They concluded that men and women have different
cardiovascular and psychological responses to mental stressors, and that
physicians need to take this research into account when evaluating and treating
patients with cardiovascular disease.
The study looked at 56 women and 254 men that were diagnosed
with heart disease and were enrolled in a larger REMIT study. These
participants were given three mentally stressful tasks, and then given a
treadmill exercise test. Researchers conducted electrocardiography of the
heart, took blood samples, and measured blood pressure and heart rate changes.
They were able to conclude that men had a greater change in
blood pressure and heart rate due to the mental stress. Conversely, they
discovered that women experienced myocardial ischemia, which is a decrease in
blood flow to the heart, as well as experiencing increased platelet
aggregation, which is how blood clots start to form. Additionally, when
compared to men, the researchers saw that women expressed more negative
emotions during the mental stress test.
Taken at face value, we can see that both men and women
respond physiologically very differently to mental stressors. If physicians do
not understand the unique risks for men vs women due to mental stress and how
it can affect their on cardiovascular response, then they could be missing a vital
component necessary for diagnosing and treating these patients.
The researchers do go on to say that further studies are
needed to further understand the sex differences in cardiovascular response.
However, I believe that this initial research has provided new understanding
about the link between a patient’s sex, mental stress response, and
cardiovascular implications.
References:
http://www.medicalnewstoday.com/articles/283808.php
References:
http://www.medicalnewstoday.com/articles/283808.php
Thank you for your posting Paul!
ReplyDeleteI knew that heart disease is the leading cause of the death among males in the United States, however, I did not realize that the stress could induce myocardial ischemia. Is it resulted from accumulation of cholesterol molecules in the blood vessels, as in atherosclerosis?
Also, is there any rationale for the researchers to study on more male participants than females (254 vs. 56)?
Thank you for the information, Paul.
Best,
Minwoo
Interesting post! I've read that men tend to have a "flight or fight" response to stress while women more often exhibit "tend and befriend" reactions. According to an article in Psychology Today, this difference may be the result of a single gene expression: the SRY gene on the male Y chromosome. Among other functions, the resultant SRY protein is involved in regulating the secretion of catecholamines that affect stress response (http://www.psychologytoday.com/blog/games-primates-play/201203/gender-differences-in-responses-stress-it-boils-down-single-gene). Wonder if SRY is further involved in cardiovascular response...
ReplyDeleteThis is a fascinating article, Paul! It's awesome that you touched on such a valid issue when it comes to realistic clinical encounters with patients regarding stress. It's important to understand the differences in stress manifestations when it comes to gender. A result of this understanding would be tailored treatments for the patients that are specific to their needs. I was also wondering, like Minwoo, if you knew why the study conducted more research on women than men? It would be interesting to understand the reason for the polarizing gender numbers. Additionally, I found an article by the American Psychological Association that further supports your argument about the different physiological manifestations of stress observed between women and men (http://www.apa.org/news/press/releases/stress/2010/gender-stress.aspx). Great post!
ReplyDeleteI agree with MinWoo, Sarah, and Lorraina this is a very interesting article! I know that this is geared specifically towards males and females, but I was wondering if this study also included pseudohermaphroditism and pure hermaphroditism. Would their stress levels be similar to males if they present as female or vice versa, or when they have both genitalia. I was reading a case study of a female pseudohermaphrodite and found that they may suffer from adrenal crisis but they were given medication to prevent such occurrence (http://link.springer.com/article/10.1007/BF03343729#page-1). I understand that it's more complicated than having different internal sex organs from what one is presenting externally, but I was wondering what your thoughts were on that? Are their stress levels synonymous with the findings of males and females, or do they experience differently because the sex is a bit more complicated?
ReplyDeleteAlso, I was wondering if you had any thoughts on why individuals presenting with pseudohermaphroditism are at risk of adrenal crisis? My only thought was that some type of complication occurred during the developmental stages while still in the mothers womb, but I am not quite sure. What do you think?
Hey Paul, interesting blog!
ReplyDeleteMales and females also present myocardial infarction with different symptoms. The common nomenclature of today in regards to MI is: crushing chest pain, left arm pain, back pain, etc. As future health care providers, the information that you presented has to be better understood so that patients have a better long term outcome in regards to cardiovascular disease.
Canto et. al conducted a clinical study on patients that were admitted to the hospital because of MI. Females who were admitted tended to be older and had a higher mortality rate. Interestingly, it was not necessarily their increased age that caused their increased mortality rate. It was because 1. they were women, 2. they did not present with chest pain.
According to the study, firstly, patients who presented with chest pain were treated more effectively and diagnosed properly for MI than those who did not. Secondly, women who complain of pain are much more likely to not be taken seriously than men who complain of pain. Hopefully, when we become physicians, physician assistants, and dentist, we will not follow in the footsteps of our predecessors.
Canto J, Rogers W, Goldberg R, Peterson E, Wenger N, Vaccarino V, Kiefe C, Frederick P, Sopko G, Zheng Z. 2012. Association of Age and Sex with Myocardial Infarction Symptom Presentaiton and In-Hospital Mortalilty. JAMA. 307(8): 813-822.
Loss of appetite is another sign of a cardiac problem. Those who are having trouble with their heart tend to feel full more often and may also experience nausea and constipation, which makes it less desirable for them to eat. The symptoms and heart attack failure causes are given in much detail on the doctor bing article Treat heart attack he is the heart specialist. Your article is also fantastic and I appreciate you on this. Thanks!! Keep sharing this type useful information
ReplyDelete