Myocardial Ischemia in Coronary Disease

In this issue of the Journal, Rozanski and colleagues offer evidence that different forms of mental stress can provoke transient myocardial ischemia in patients with coronary artery disease.1 The performance of mathematical calculations and formal psychological testing (the Stroop color–word test) both produced moderate increases in heart rate and blood pressure and resulted in myocardial ischemia as assessed by the development of wall-motion abnormalities, ST-segment changes, or angina pectoris. Giving a speech to an audience about personal matters produced more substantial increases in double product (heart rate times systolic blood pressure) and evidence of even more extensive ischemia. Finally, . . .