Am J Psychiatry 1994; 151:1140-1147
Copyright © 1994 by American Psychiatric Association
Cardiac denervation and cardiovascular reactivity to psychological stress
PA Shapiro, RP Sloan, JT Bigger Jr, E Bagiella and JM Gorman
Department of Psychiatry, Columbia University, New York, NY 10032.
OBJECTIVE: This study investigated the mechanisms responsible for increases
in heart rate and blood pressure during psychological stress, which are
incompletely understood. Since cardiac transplant patients have denervated
hearts, they provide a unique model for isolating central versus peripheral
influences on the cardiovascular response to stress. METHODS: The authors
compared the responses to two laboratory stressors of 20 ambulatory heart
transplant recipients and two groups of normal subjects, one whose ages
were matched to the ages of the transplant patients (mean = 46 years) and
one whose ages were matched to the ages of the heart donors (mean = 27
years). The three groups of subjects performed mental arithmetic and
reaction time tasks. RESULTS: Heart rate increase during the mental
arithmetic task was significantly attenuated in the transplant recipients.
During stress, stroke volume increased in the transplant recipients but
decreased in both groups of comparison subjects. The difference in age
between the heart recipients and donors did not account for the difference
in reactivity between the heart transplant patients and the normal
subjects. CONCLUSIONS: Direct neural stimulation of the heart is more
important than peripherally circulating factors in producing tachycardia
during psychological stress. Cardiac but not vascular responses to
psychological stress are altered by cardiac denervation.
