Psychological Stress, Inflammation, Immunity, and Coagulation Intertwining in Ischemic Heart Disease

Stress responses with neural modulation of immunity and coagulation have an important role as predisposing, precipitating, or aggravating factors in ischemic heart disease. Acute mental or emotional stress is a frequent cause of myocardial ischemia, exerting its effects through an extremely complex system of processes that encompass a central multineural network, a hormonal cascade, and peripheral neural pathways. Some of the negative effects of stress responses are mediated by inflammation; but, when stress becomes chronic, the inflammation detaches from upper-level control, and wider processes that involve behavior, metabolism, and adipocytes take place. Inflammation with innate and specific immunity, in turn, is independently implied in the pathogenesis of ischemic heart disease. Psycho-neural processes influence inflammation/immunity by releasing neuromediators at local sympathetic nerve terminals, which regulate the response of immune cells. In turn, psycho-neural processes are also modulated by inflammatory byproducts.