Stress May Predict Chest Pain In People With Heart Disease, Study Says

Chest pain, or angina1, is a common symptom of heart disease, caused by a lack of blood flow to the heart. Despite the heart's role in angina, research from the American Heart Association found stress may also contribute—plus, the specific brain activity that may predict its onset.

Previous research suggested a link between mental stress and angina2, without a clear indication of how or why. To better understand the association, participants underwent mental stress testing, brain imaging scans, and heart imaging scans—all while being monitored for chest pain. 

The brain scans specifically measured activity in the inferior frontal lobe, which is responsible for emotional regulation and stress. Participants answered questionnaires about their chest pain and cardiovascular activity for the baseline data, then again two years later for a follow-up. 

After analyzing the results, researchers found people with more severe chest pain also experienced greater activity in the inferior frontal lobe while stressed. These findings were consistent in the two-year follow-up. 

The study proves stress is an important factor in chest pain and should be considered during treatment planning. 

"The top three factors that explained angina frequency were all stress-related, including brain activation, depressive symptoms, and PTSD symptoms," Shah says. "This is surprising because when we manage angina in clinical settings, we normally do not consider stress as an underlying factor, and rather focus on blood flow in the heart."