Ending the silence of the heart

Questions why some people with heart disease suffer from terrible chest pains that warn them of their dangerous condition, while others feel nothing at all and die suddenly. Chief of behavioral medicine at the National Heart, Lung, and Blood Institute in Bethesda, Maryland, Peter Kaufmann; Kaufmann's belief that the answer may be firmly rooted in psychology; Silent bouts of myocardial ischemia (SMI); Beta-endorphin; Details.

By PT Staff, published on July 01, 1993

CARDIOVASCULAR DISEASE

FOR HEART RESEARCHER Peter Kaufmann, it's not the pain but the lack of it that is most puzzling about heart disease.

Why is it, he asks, that some people with heart disease suffer from terrible chest pains that warn them of their dangerous condition, while others feel nothing at all and spontaneously drop dead none the wiser?

The answer may be firmly rooted in psychology, says Kaufmann, chief of behavioral medicine at the National Heart, Lung, and Blood Institute in Bethesda, Maryland.

Doctors know that mental stress tends to provoke myocardial ischemia, a lack of blood flow to the heart usually accompanied by difficulty breathing-and sharp chest pains. But nearly 80% of the 4 million Americans with coronary heart disease suffer from silent bouts of myocardial ischemia (SMI). Almost half die without ever knowing what hit them. Only in autopsy do the diseased arteries show up.

"If we can learn something about the types of patients who get silent heart attacks, we may be able to improve medical care by predicting the mental circumstances in which ischemic episodes occur," explains psychologist Kaufmann. A new multicenter study probing the mind-body connection in SMI is about to get under way.

High-tech gadgetry will monitor hearts on the move and tell when, if ever, subjects experience SMI. At the same time, researchers will measure blood hormone levels and sensitivity to pain, as well as response patterns to psychological and mental stress.

Scientists know that people release different amounts of beta-endorphin, a natural painkiller, when under stress. Perhaps, says Kaufmann, those with SMI release more of the hormone, masking any pain. Or maybe people with high levels of stress who get SMI perceive pain differently or have diseased heart tissue in different locations than the nonstressed.

For now, Kaufmann advises, a few things may help deter the silent killer. Stop smoking, of course. while not yet proved, you might try A practicing meditation, progressive muscle relaxation, imagery, and other techniques in or to help control effects of your stress.

ILLUSTRATION (LIZ NEWKIRK)