A microvascular-myocardial diastolic dysfunctional state and risk for mental stress ischemia: a revised concept of ischemia during daily life.

To improve our understanding of pathophysiological responses to stress in “triggering” adverse events, stressors have been used in the laboratory to evoke “mental stress–induced ischemia” (MSIMI). Our studies found that patients withMSIMI had increased risk for death (1), and their hemodynamic and neurohormonal changes differed from those observed with exercise (2). Mental stress increased heart rate, systolic blood pressure, cardiac output, and systemic