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Mental Stress May Induce QT-Interval Prolongation and T-Wave Notching

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Background: The effects of active and passive mental stress (PMS) on the QT interval were studied by using an intraindividual regression method of QT-interval correction for heart rate.

Methods: Thirty healthy males (age 21.2 ± 1.8 years) performed a mental arithmetic for 1 minute, which was considered as active mental stress (AMS) because of the performance requirement. A 1-minute unpleasant video clip was used for PMS. Two baseline and two (an early and a late) ECGs were prepared in both mental stress periods. The individual QT–RR relationship was assessed by linear regression analysis of 7–15 (11.0 ± 1.9) controlled QT–RR data pairs, also obtained from ECGs gained during a successive set of 9 isometric stretching exercises.

Results: Heart rate has increased significantly at both measurements in response to AMS (P < 0.0001), but not in response to passive stress. QTc significantly prolonged early in AMS (P = 0.0004), then normalized by the end of the period. During PMS, no significant QTc changes were observed. The evolution of bifid T waves was noted in 14 subjects: 8 presented bifid T waves during both AMS and exercise, and 6 during only exercise.

Conclusions: AMS and PMS elicit different cardiovascular reactions. Our results indicate that changes in the autonomic tone, probably abrupt sympathetic predominance, may cause QTc prolongation and bifid T waves. This suggests that besides stress quality and intensity, the dynamics of stress application and perception also influence repolarization.

A.N.E. 2007;12(3):251–259
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Keywords: QT interval; T wave; autonomic modulation; mental stress; sympathetic activity

Document Type: Research Article

Affiliations: Department of Cardiology, Saint Francis Hospital, Budapest, Hungary

Publication date: July 1, 2007

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