Abstract
Although the relationship between vasospastic angina and stress has been pointed out, there are few studies focusing on this relationship. This study, therefore, explores the relationship between stress and the deterioration of vasospastic angina through four patients with vasospastic angina who showed alexithymia, over-adaptation and poor awareness of stress. Four patients with vasospastic angina resistant to treatment were followed for an average of three years. In these cases, coronary spastic obstruction without significant coronary stenosis was documented by ergonovine maleate infusion to the coronary artery. Various psychological tests including the MMPI Alexithymia Scale, CMI, SDS test, and a structured interview for type A behavior pattern were performed on these patients. These tests and clinical interviews showed the following psychological and behavioral characteristics : l) All of these patients had the alexithymic trait and the tendency to over-adaptation. 2) Case 3 was neurotic, and case 1 and 3 had depression. 3) Only one (case 4) showed type A behavior pattern. Case 1,2,and 4 were obviously under chronic stress and case 3 had a history of peptic ulcer and bronchial asthma, both of whom were resistant to treatment. All of our cases were supposed to be under chronic stress. Three (case 1,2,and 4) of them showed marked deterioration of vasospastic angina and preceding acutely stressful events were documented at almost all episodes. The remaining one (case 3) also showed marked deterioration, but acutely stressful event proceeding each of the episodes could not be documented. Case 1 had manic depressive disorder, and suffered four relapses of the disorder followed by marked deterioration of vasospastic angina. Though each of four patients showed poor awareness of stress, improving their awareness of stress seemed to be effective in preventing or suppressing the deterioration of vasospastic angina. It is supposed that the alexithymic trait, the tendency to over-adaptation, and poor awareness of stress play important roles in producing chronic stress. The alexithymic trait and the overadaptative tendency, combined with mental and/or physical strains, easily produced a chronic stress state in these patients. It is assumed that the addition of an acutely stressful event to patients with vasospastic angina under chronic stress leads to marked deterioration of vasospastic angina. It took more than several days for an acutely stressful event to evoke deterioration of vasospastic angina. When managing patients with vasospastic angina, it is important to know that the alexithymic trait, the tendencies to over-adaptation, poor awareness of stress, and stress itself play important roles in causing deterioration of vasospastic angina.
