Acute Mental Stress Found to Elicit aPWA, Myocardial Ischemia in Stable CHD

woman that is stressed out
woman that is stressed out
Acute mental stress was found to elicit an abnormal P-wave axis in some individuals with stable coronary heart disease.

Acute mental stress was found to elicit an abnormal P-wave axis (aPWA) in some individuals with stable coronary heart disease (CHD), according to study results published in the Journal of Electrocardiology.

In this study, 359 patients with stable CHD (mean age, 56±9.9 years; 62.4% men; 42.9% white) with normal PWA (0°-75°) at baseline were drawn from 2 parallel studies conducted between June 2011 and March 2016: the Mental Stress and Myocardial Ischemia After Myocardial Infarction: Sex Differences and Mechanisms-2 (n=205; 57.1%) trial and the Mental Stress Ischemia Mechanisms and Prognosis Study (n=154; 42.9%).

Mental stress was tested using a standardized public speaking task following 30 minutes of rest. Single-photon emission computed tomography myocardial perfusion imaging was conducted at rest and during mental and conventional stress. Digital electrocardiograms (12-lead; 10 s each) were conducted at rest, and 2 and 5 (recovery) minutes after the speech stress. The study’s primary outcome was the percentage of patients who developed incident aPWA.

There were 46 patients (12.8%) in the cohort who developed aPWA, of which 43 (12.0%) developed during the stress task, and 12 (3.3%) during the recovery phase. Stress-induced elevation in heart rate was associated with an increased risk for aPWA in the entire cohort (odds ratio [OR] per 5-unit increase, 1.16; 95% CI, 1.03-1.30). An association between mental stress-induced myocardial ischemia and a higher risk for incident aPWA was established in women (OR, 5.22; 95% CI, 1.74-15.6), but not men (OR, 0.11; 95% CI, 0.01-1.01; Pinteraction =.004).

Study limitations include a lack of clinical outcome data and the inability to determine the pathophysiological mechanisms underlying the observed associations.

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“Our data suggest that acute psychological stress can promote adverse transient electrical changes in the atria that may predispose to [atrial fibrillation],” noted the authors.

Funding and Conflicts of Interest Disclosures:

Please see original article for funding information.


Almuwaqqat Z, O’neal WT, Hammadah M, et al. Abnormal P-wave axis and myocardial ischemia development during mental stress. J Electrocardiol. 2020;60:3-7. doi:10.1016/j.jelectrocard.2020.02.019