Comparison of treadmill exercise testing and psychologic stress testing soon after myocardial infarction

Are physical or psychologic stressors more useful for evaluating psychologic stress in patients with coronary heart disease? To evaluate this question, patients underwent physical and psychologic testing 7 weeks after myocardial infarction. The psychologic stress test consisted of an open-ended interview, a videotape depicting stressful scenes and a puzzle task. In 20 men whose mean age ± standard deviation was 52 ± 1 years, the interview produced the following peak heart rate and systolic blood pressure responses: 83 ± 18 beats/min and 140 ± 13 mm Hg, which were 8 and 10 percent, respectively, above values at rest ( P < 0.05). Symptom-limited treadmill exercise testing in 10 of these patients elicited maximal heart rate and systolic blood pressure values of 152 ± 24 beats/min and 172 ± 32 mm Hg, respectively; ischemic S-T segment depression or angina pectoris occurred in 6 of the 10 patients, whereas none had demonstrated ischemia with psychologic testing. A second consecutive series of 20 patients demonstrated cardiovascular responses to physical and psychologic stress similar to those of the first series. Again, ischemic abnormalities were absent during psychologic stress, whereas exercise-induced ischemic abnormalities were noted in 3 of 20 patients. Ischemic abnormalities are unlikely to appear during psychologic stress testing in patients with a high heart rate and systolic blood pressure threshold for ischemic abnormalities during exercise testing. Standard methods of physical exercise testing are superior to currently available psychologic stress tests for evaluating the cardiovascular response to most commonly encountered psychologic stressors.