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Effects of anger on left ventricular ejection fraction in coronary artery disease

  • Gail Ironson
    Affiliations
    From the Departments of Psychology and Psychiatry, University of Miami, Coral Gables, Florida, U.S.A.

    From the Department of Psychiatry, Stanford University School of Medicine, Stanford, California, U.S.A.

    Veterans Administration Medical Center, Palo Alto, California, U.S.A.

    Prevention Sciences Center, University of California, San Francisco, California, U.S.A.
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  • C.Barr Taylor
    Correspondence
    Address for reprints: C. Barr Taylor, MD, Behavioral Medicine Program, Psychiatry Department, TD209, Stanford University School of Medicine, Stanford, California 94305-5490.
    Affiliations
    From the Departments of Psychology and Psychiatry, University of Miami, Coral Gables, Florida, U.S.A.

    From the Department of Psychiatry, Stanford University School of Medicine, Stanford, California, U.S.A.

    Veterans Administration Medical Center, Palo Alto, California, U.S.A.

    Prevention Sciences Center, University of California, San Francisco, California, U.S.A.
    Search for articles by this author
  • Michael Boltwood
    Affiliations
    From the Departments of Psychology and Psychiatry, University of Miami, Coral Gables, Florida, U.S.A.

    From the Department of Psychiatry, Stanford University School of Medicine, Stanford, California, U.S.A.

    Veterans Administration Medical Center, Palo Alto, California, U.S.A.

    Prevention Sciences Center, University of California, San Francisco, California, U.S.A.
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  • Thomas Bartzokis
    Affiliations
    From the Departments of Psychology and Psychiatry, University of Miami, Coral Gables, Florida, U.S.A.

    From the Department of Psychiatry, Stanford University School of Medicine, Stanford, California, U.S.A.

    Veterans Administration Medical Center, Palo Alto, California, U.S.A.

    Prevention Sciences Center, University of California, San Francisco, California, U.S.A.
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  • Charles Dennis
    Affiliations
    From the Departments of Psychology and Psychiatry, University of Miami, Coral Gables, Florida, U.S.A.

    From the Department of Psychiatry, Stanford University School of Medicine, Stanford, California, U.S.A.

    Veterans Administration Medical Center, Palo Alto, California, U.S.A.

    Prevention Sciences Center, University of California, San Francisco, California, U.S.A.
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  • Margaret Chesney
    Affiliations
    From the Departments of Psychology and Psychiatry, University of Miami, Coral Gables, Florida, U.S.A.

    From the Department of Psychiatry, Stanford University School of Medicine, Stanford, California, U.S.A.

    Veterans Administration Medical Center, Palo Alto, California, U.S.A.

    Prevention Sciences Center, University of California, San Francisco, California, U.S.A.
    Search for articles by this author
  • Susan Spitzer
    Affiliations
    From the Departments of Psychology and Psychiatry, University of Miami, Coral Gables, Florida, U.S.A.

    From the Department of Psychiatry, Stanford University School of Medicine, Stanford, California, U.S.A.

    Veterans Administration Medical Center, Palo Alto, California, U.S.A.

    Prevention Sciences Center, University of California, San Francisco, California, U.S.A.
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  • George M. Segall
    Affiliations
    From the Departments of Psychology and Psychiatry, University of Miami, Coral Gables, Florida, U.S.A.

    From the Department of Psychiatry, Stanford University School of Medicine, Stanford, California, U.S.A.

    Veterans Administration Medical Center, Palo Alto, California, U.S.A.

    Prevention Sciences Center, University of California, San Francisco, California, U.S.A.
    Search for articles by this author
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      Abstract

      This study examined the comparative potency of several psychological stressors and exercise in eliciting myocardial ischemia as measured by left ventricular (LV) ejection fraction (EF) changes using radionuclide ventriculography. Twenty-seven subjects underwent both exercise (bicycle) and psychological stressors (mental arithmetic, recall of an incident that elicited anger, giving a short speech defending oneself against a charge of shoplifting) during which EF, blood pressure, heart rate and ST segment were measured. Eighteen subjects had 1-vessel coronary artery disease (CAD), defined by >50% diameter stenosis in 1 artery as assessed by arteriography. Nine subjects served as healthy control subjects. Anger recall reduced EF more than exercise and the other psychological stressors (overall F [3.51] = 2.87, p = .05). Respective changes in EF for the CAD patients were −5% during anger recall, +2% during exercise, 0% during mental arithmetic and 0% during the speech stressor. More patients with CAD had significant reduction in EF (≥7%) during anger (7 of 18) than during exercise (4 of 18). The difference in EF change between patients with CAD and healthy control subjects was significant for both anger (t25 = 2.23, p = 0.04) and exercise (t25 = 2.63, p = 0.01) stressors. In this group of patients with CAD, anger appeared to be a particularly potent psychological stressor.
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