Facial expression and the affective component of cynical hostility in male coronary heart disease patients.

This study describes the affective component of hostility as measured by the Cook-Medley Hostility Scale (Ho W. Cook & D. Medley, 1954) by examining the relationship between facial expressions of emotion and Ho scores in 116 male coronary heart disease patients. Patients underwent the videotaped Type A Structured Interview, from which facial expressions were later coded using the Facial Action Coding System. They also completed the Cook-Medley Ho scale. Facial expression of the emotion of contempt was significantly related to Ho scores; anger expression was not. Also, there was a significant interaction between hostility and defensiveness, wherein low-defensive, highly hostile people showed substantially more contempt expression than others. The implications of these findings for the construct validity of Ho and for identifying clinically important subtypes of hostility are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anger report predicts coronary artery vasomotor response to mental stress in atherosclerotic segments

To determine the effects of anger on coronary artery vasoconstriction, 12 patients with symptomatic myocardial ischemia were studied during cardiac catheterization. During catheterization, the patients were asked to recall a recent event that had produced anger. One narrowed and 2 non-narrowed arterial segments were selected using predetermined criteria. Patients also completed various self-report measurements upon entering the catheterization laboratory before any procedures, after completion of the clinical angiogram and after the anger recall stressor. There was a significant increase in subject reports of anger (F[1,6] = 21.94, p < 0.01) and arousal (F [2,6] = 5.49, p < 0.05) during the anger stressor. There were no significant changes in heart rate, systolic or diastolic blood pressure, or heart rate x systolic blood pressure product during the anger stressor. A total of 27 arterial segments (9 narrowed and 18 non-narrowed) were selected and analyzed using quantitative angiographic techniques. Repeated-measures analysis of variance (baseline vs anger stressor) found no significant group differences with regard to changes in arterial diameter between conditions or among segments. Reported anger was significantly correlated with a decrease in both mean (r = -0.76, p < 0.05) and minimal (r = -0.82, p < 0.05) diameter changes in narrowed arteries. Vasoconstriction only occurred with high levels of anger. There were no significant correlations between anger report and diameter change in non-narrowed arteries. Thus, anger may produce coronary vasoconstriction in previously narrowed coronary arteries.     

Patterns of emotion expression during separation in the strange-situation procedure.

The facial expressions of 28 13-mo-old middle-class children were videotaped during the 3-min separation episode of the Ainsworth strange-situation procedure (ASSP). Facial behavior was analyzed to determine the patterns of emotional expressions during separation and to assess the relations between these patterns and types of attachment as assessed by the ASSP. Findings reveal that anger was the dominant negative emotion expressed by the majority of Ss in each of 3 ad hoc groups determined by level of negative emotion. Some high-negative emotion expressers displayed predominantly anger and others mainly sadness. Patterns of emotion expression varied with type of attachment; Ss who showed an insecure-resistant attachment pattern displayed less interest and more sadness than Ss in the securely attached groups. The proportion of time anger was expressed did not differ significantly with type of attachment. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Continuities and changes in emotion expressions during brief separation at 13 and 18 months.

16 children were videotaped at 13 and 18 mo of age during the strange-situation procedure (M. D. Ainsworth et al, 1978). Facial expressions (interest, anger, sadness, and emotion blends) during the 2nd separation episode were coded using a system for identifying affect expressions by holistic judgments (Affex) developed by the 2nd author and colleagues (1980). Results show significant continuities in proportion of interest expressions, anger, emotion blends and frequency of expression changes. The major developmental change was seen in an age?×?emotion interaction, showing an increase in the use of facial expression blends or combinations from 13 to 18 mo. Results support the belief that patterns of emotion reflect early, persistent individual differences; they also reflect a developmental trend toward increasing complexity of emotional responses. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Violation of expectancy, loss of control, and anger expressions in young infants.

This study examined facial expressions in relation to cognition in infants aged 2–8 months. Eighty infants, divided equally among 4 age groups (2, 4, 6, and 8 months) participated. Forty-eight Ss received an audiovisual stimulus contingent on arm movement, and 32 infants did not control the stimulus. Infant facial expressions during learning and extinction were coded using the Maximally Discriminative Facial Movement Coding System (MAX). Infants in the contingent group expressed greater interest and joy during learning and greater anger during extinction. There was a high concordance between arm pulling and the expression of anger during extinction, indicating that a brief exposure to extinction produces frustration-like changes in emotional responsivity. Individual differences existed in infant responses to frustration during extinction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Facial expressions of emotion and the course of conjugal bereavement.

The common assumption that emotional expression mediates the course of bereavement is tested. Competing hypotheses about the direction of mediation were formulated from the grief work and social-functional accounts of emotional expression. Facial expressions of emotion in conjugally bereaved adults were coded at 6 months post-loss as they described their relationship with the deceased; grief and perceived health were measured at 6, 14, and 25 months. Facial expressions of negative emotion, in particular anger, predicted increased grief at 14 months and poorer perceived health through 25 months. Facial expressions of positive emotion predicted decreased grief through 25 months and a positive but nonsignificant relation to perceived health. Predictive relations between negative and positive emotional expression persisted when initial levels of self-reported emotion, grief, and health were statistically controlled, demonstrating the mediating role of facial expressions of emotion in adjustment to conjugal loss. Theoretical and clinical implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of brain electrical activity during facial signs of emotion in 10-month-old infants.

This study examined electroencephalogram (EEG) asymmetries during the presence of discrete facial signs of emotion. Thirty-five 10-month-old infants were tested in a standard stranger- and mother-approach paradigm that included a brief separation from their mother. Infant facial expression was videotaped, and brain electrical activity from left and right frontal and parietal regions was recorded. The videotapes were coded with two different discrete facial coding systems. Artifact-free periods of EEG were extracted that were coincident with the expression of the emotions of joy, anger, and sadness. The data revealed different patterns of EEG asymmetry depending on the type of facial expression and vocal expression of affect that was observed. Expressions of joy that involved facial actions of both zygomatic and orbicularis oculi were seen more often in response to mother approach, whereas smiles that did not involve the action of orbicularis oculi were seen more often in response to approach of the stranger. The former type of smile was associated with relative left frontal activation, whereas the latter type was associated with right frontal activation. Facial expressions of anger and sadness exhibited in the absence of crying were associated with left frontal activation, whereas these same facial expressions during crying were associated with right frontal activation. These data underscore the usefulness of EEG measures of hemispheric activation in differentiating among emotional states associated with differences in facial and vocalic expressivity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The importance of ambulatory ECG monitoring for determining the prognosis of patients with stable stenocardia]

149 patients with coronary artery disease and stable angina pectoris underwent coronary angiography and had coronary artery stenosis over 50 per cent. All the patients were also subjected to 24-h Holter monitoring at primary examination and 12-18 months after it. Typical ischemic ST changes were defined by transient horizontal or descending ST depressions > 1.0 mV (measured 80 ms after the J point) lasting at least for a minute. 75 (50.3 per cent) patients had episodes of silent myocardial ischemia. The course of the disease was assessed in follow-up period of 12-18 months. Four variants of the course were determined: cardiac events (16 patients), the disease progression (33 patients), a stable course (75 patients), clinical remission (25 patients). A significant correlation between the occurrence, the slope and duration of silent ischemia, the data of selective coronary angiography and clinical course of ischemic heart disease was established. Cardiac events occurred in 87.5% of the patients with silent myocardial ischemia who had total ischemic burden 30 minutes or more and/or ST-segments decrease 3.0 mm and more during heart rate less than 100 beat-min. The stable course was registered in patients with silent ischemia or without it with similar frequency. Clinical remission of angina pectoris in the patients with silent ischemia was observed rarely. The results of this study demonstrate that silent ischemia is an important prognostic factor.     

Emotional reactions to a political leader's expressive displays.

40 undergraduates viewed videotaped excerpts of happiness/reassurance, anger/threat, and fear/evasion expressive displays by US President Ronald Reagan. Within each display condition 1 excerpt was presented in image-only and 1 in sound-plus-image format. Emotional reactions were assessed by facial electromyography (EMG) from the brow and cheek regions, skin resistance, and heart rate. Following each excerpt, Ss also verbally reported the intensity of 8 emotions, including joy, interest, anger, and fear. Findings indicate that self-reported emotions were influenced strongly by both the expressive displays and prior attitude toward Reagan and by media condition. Facial EMG indicated smiling during happiness/reassurance displays and frowning during anger/threat and fear/evasion displays, especially during image-only presentations. Display effects were also found for skin resistance responses when the media conditions were combined and for heart rate changes in the sound-plus-image condition. Results indicate that expressive displays had a direct emotional impact on viewers and that prior attitudes influenced retrospective self-reports of emotion. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developmental toxicity of steviol, a metabolite of stevioside, in the hamster

Family history of hypertension (positive and negative) and gender groups were compared on cardiovascular responses at rest, during stressors and during recovery. Two tasks were employed, mental arithmetic and an anger recall interview. Both levels and reactivity measures of blood pressure, heart rate, cardiac output and total peripheral resistance were included. In addition, participants filled out several questionnaires measuring state feelings during the task and recovery periods, trait anger/hostility and emotions. Both men and women with a positive family history of hypertension exhibited higher tonic levels of blood pressure and heart rate at rest, recovery and during both tasks. They also exhibited greater heart rate reactivity during the mental arithmetic task and greater blood pressure reactivity to both tasks when post-math recovery, but not initial rest, was used as a covariate. Positive family history individuals reported less trust and gregariousness, more depression and aggression, less awareness of somatic responses to the tasks and less effort to relax during the post-task rest periods. Finally, significant correlations were found between low anger expression how anger experience and high anger control and task SBP levels in positive family history individuals.     

Anxiety and sensitivity to gaze direction in emotionally expressive faces.

This study investigated the role of neutral, happy, fearful, and angry facial expressions in enhancing orienting to the direction of eye gaze. Photographs of faces with either direct or averted gaze were presented. A target letter (T or L) appeared unpredictably to the left or the right of the face, either 300 ms or 700 ms after gaze direction changed. Response times were faster in congruent conditions (i.e., when the eyes gazed toward the target) relative to incongruent conditions (when the eyes gazed away from the target letter). Facial expression did influence reaction times, but these effects were qualified by individual differences in self-reported anxiety. High trait-anxious participants showed an enhanced orienting to the eye gaze of faces with fearful expressions relative to all other expressions. In contrast, when the eyes stared straight ahead, trait anxiety was associated with slower responding when the facial expressions depicted anger. Thus, in anxiety-prone people attention is more likely to be held by an expression of anger, whereas attention is guided more potently by fearful facial expressions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coronary vascular response to the cerebral ischemia reflex

Most centrally mediated sympathoexcitatory reflexes produce increases in arterial pressure, heart rate, and peripheral vascular resistance, including coronary vasoconstriction. Cerebral ischemia also causes large increases in arterial pressure and peripheral vasoconstriction but with modest or variable changes in heart rate. To examine the effect of cerebral ischemia on coronary vascular resistance, we produced cerebral ischemia in 14 cats by occluding the right brachiocephalic and left subclavian arteries for 30 seconds. After vagotomy and beta-blockade, a marked increase in arterial pressure (89 +/- 14%) and coronary vascular resistance (52 +/- 7%) was seen. After inhibition of the carotid baroreceptor reflex by surgical denervation and application of topical lidocaine, the increase in arterial pressure to cerebral ischemia was not affected, but the increase in coronary vascular resistance was attenuated (33 +/- 6%; p < 0.05 versus before denervation) to a level expected with autoregulation. To evaluate the possible contribution of the chemoreflex on coronary blood flow during cerebral ischemia, we conducted separate experiments in which nicotine was injected into both carotid arteries. Coronary constriction was not observed. Adrenalectomy and upper extremity ischemia likewise did not alter coronary vascular resistance. We conclude that cerebral ischemia elicits neurally mediated coronary vasoconstriction as a result of baroreceptor hypotension rather than directly. The relative absence of neurogenic coronary constriction and changes in heart rate suggest that sympathoexcitation during cerebral ischemia is directed more toward the peripheral vasculature than the heart.     

Coronary vasoconstriction during myocardial ischemia induced by rises in metabolic demand in patients with coronary artery disease

BACKGROUND: In patients with coronary artery disease, a maximal vasodilation of the coronary microcirculation is generally assumed to occur during myocardial ischemia induced by rises in metabolic demand. However, vasoconstriction has been documented during severe prolonged ischemia in animals. The aim of this study was to investigate coronary vasomotor tone during pacing-induced ischemia in humans. METHODS AND RESULTS: The study included 11 patients with exercise-induced ischemia and single-vessel disease of the left anterior descending artery and 7 control subjects with normal coronary arteries. Blood flow velocity was monitored with a Doppler catheter in the left anterior descending artery. Coronary resistance index was calculated as the ratio between mean arterial pressure and flow velocity. Measurements were obtained at baseline, after intracoronary adenosine (2 mg), and during maximal atrial pacing in the absence and presence of adenosine. After adenosine administration at rest, coronary resistance decreased more in control subjects than in patients (25 +/- 7% of baseline versus 61 +/- 19%; P < .01). Coronary resistance decreased in all control subjects (P < .01) both at maximal pacing (60 +/- 17% of baseline) and after administration of adenosine during tachycardia (31 +/- 13% of baseline). By contrast, all 10 ischemic patients displayed increased coronary resistance at maximal heart rate (221 +/- 131% of baseline; P < .01 versus baseline, P < .01 versus control subjects). At this stage, adenosine decreased coronary resistance to 44 +/- 20% of values observed before injection. Additionally, it reduced ST-segment depression in 5 of 8 patients. CONCLUSIONS: In patients with coronary artery disease, transient myocardial ischemia induced by increased metabolic demand is not associated with maximal vasodilation. Rather, an inappropriate severe microvascular vasoconstriction is present that can be abolished by intracoronary adenosine.     

Contextual determinants of anger and other negative expressions in young infants.

Two experiments examined how different frustration contexts affect the instrumental and emotional responses of 4- to 5-month-old infants. Three different frustrating contexts were investigated: loss of stimulation (extinction), reduction in contingent stimulation (partial reinforcement), and loss of stimulus control (noncontingency). In both experiments, changes in arm activity and facial expressions of anger and sadness coded according to the Maximally Discriminative Facial Movement Coding System (MAX) were the measures of frustration. Both experiments showed that (a) arm responses increased when the contingent stimulus was lost or reduced but decreased when control of the stimulus was lost under noncontingency, (b) MAX-coded anger, but not MAX-coded sad or blends of anger and sad, was associated with frustration, and (c) the pattern of anger and arm responses varied with the frustration context. When contingent stimulation was lost or reduced, both anger and arm responses increased, but when expected control was lost under noncontingency, arm responses decreased while anger increased. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Biobehavioral aspects of cardiovascular disease: Progress and prospects.

Discusses the impact of psychosocial factors, personality traits, genetic-behavioral interactions, sodium sensitivity, obesity, insulin metabolism, and psychophysiology on hypertension status. It is proposed that an understanding of pathophysiologic processes is needed to provide a better basis for risk factor reduction and other aspects of treatment. The study of myocardial ischemia appears to provide an important link between the development of coronary artery disease and the occurrence of coronary heart disease. Further studies are needed to assess the clinical significance of stress-induced ischemia as well as whether mental stress is predictive of future heart disease. Associations have been made between behavioral risk factors and heart disease, but the exact nature remains to be clarified. Hostility is an important factor in the development of coronary heart disease, but its impact needs to be studied fully. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Selection for universal facial emotion.

Facial expression is heralded as a communication system common to all human populations, and thus is generally accepted as a biologically based, universal behavior. Happiness, sadness, fear, anger, surprise, and disgust are universally recognized and produced emotions, and communication of these states is deemed essential in order to navigate the social environment. It is puzzling, however, how individuals are capable of producing similar facial expressions when facial musculature is known to vary greatly among individuals. Here, the authors show that although some facial muscles are not present in all individuals, and often exhibit great asymmetry (larger or absent on one side), the facial muscles that are essential in order to produce the universal facial expressions exhibited 100% occurrence and showed minimal gross asymmetry in 18 cadavers. This explains how universal facial expression production is achieved, implies that facial muscles have been selected for essential nonverbal communicative function, and yet also accommodate individual variation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Detecting vascular problems in patients with diabetes treated with an intra-aortic balloon pump

Individuals with diabetes are at increased risk for both peripheral vascular disease and coronary artery disease. In patients with severe coronary artery disease, a cardiac assist device called an intra-aortic balloon pump (IABP) often is used to aid the failing heart and prevent further cardiac ischemia. Because this device is inserted via the femoral artery, patients are at risk of limb ischemia distal to the insertion site. Patients with diabetes are particularly prone to this complication. Detecting the early signs and symptoms of ischemia is crucial to preventing serious sequelae. Standard vascular examination techniques, in addition to being subjective and not easily reproducible, may be misleading in patients with diabetes. This article provides a review of the signs and symptoms of lower limb ischemia and noninvasive vascular tests that clinicians can use to evaluate lower extremity circulation. Also included are protocols for patient care during and after hospitalization, and two case studies of cardiac patients with diabetes who were treated with an IABP.     

Acute von Willebrand factor secretion from the endothelium in vivo: assessment through plasma propeptide (vWf:AgII) Levels

STUDY OBJECTIVES: Patients with coronary heart disease (CHD) and obstructive sleep apnea may have an increased cardiac risk due to nocturnal myocardial ischemia triggered by apnea-associated oxygen desaturation. Sleep structure in patients with obstructive sleep apnea is fragmented by activation of the central nervous system (CNS) (arousal) due to obstructive apneas. Nocturnal myocardial ischemia may lead to activation of the CNS as well. PATIENTS: Fourteen patients with obstructive sleep apnea and CHD disease and seven patients suffering from obstructive sleep apnea without CHD were studied. Overnight sleep studies and simultaneous six-lead ECG recordings were performed. In addition, sleep studies and ECG recordings were performed with administration of a sustained-release nitrate in these patients in a double-blinded crossover design. RESULTS: Analysis of three nights' recordings revealed 144 episodes of nocturnal myocardial ischemia in six subjects. Five patients had underlying CHD and one patient exhibited diffuse wall defects of the coronary arteries; also, 85.4% of ischemic episodes were concomitant with apneas and oxygen desaturation > 3%, and 77.8% of ischemic episodes occurred during rapid eye movement (REM) sleep, although total amount of REM sleep was only 18% of total sleep time. Mean oxygen saturation was significantly lower (p < 0.05) during apnea-associated ischemic episodes than during nonapnea-associated ischemia (77.3% vs 93.1%). Nitrate administration did not reduce ischemic episodes. Sleep architecture (macrostructure) exhibited a reduction in sleep stages non-REM 3 and 4 and REM sleep. Comparing the microstructure of sleep (arousals) within episodes with and without ischemia but similar criteria like sleep stage, apnea activity, and oxygen saturation, we found significantly more (p < 0.01) and severe (p < 0.001) arousals during periods with myocardial ischemia than during control episodes. In addition, microstructure of sleep was disturbed by myocardial ischemia itself in absence of apneas. CONCLUSION: It is concluded that patients with CHD and obstructive sleep apnea are endangered by apnea-associated ischemia and that these ischemic episodes lead to activation of the CNS and additional fragmentation of sleep. Patients with nocturnal ischemia should be screened for underlying sleep apnea even if nitrate therapy fails.     

A case report of ulcerative colitis complicated with protein losing enteropathy and colon cancer in a young female

AIMS: To assess the ability of dobutamine echocardiography to detect multivessel coronary artery disease and to determine predictive factors for multivessel disease with or without beta-blockers. PATIENTS AND METHODS: A total of 101 patients underwent dobutamine stress echocardiography and coronary angiography (evaluation of chest pain 76, extent of coronary disease after myocardial infarction 19, other indications 6). RESULTS: Ten patients in whom the test was prematurely terminated were excluded. Out of 91 patients who underwent dobutamine echocardiography, 54 patients had multivessel disease (sensitivity of dobutamine test 93%, specificity 46%). Heart rate at the maximum dose of dobutamine or atropine was 88 +/- 21 beats/min for multivessel diseases and 104 +/- 21 beats/min without multivessel disease (p < 0.001). A cut-off value < 94 beats/min discriminated patients at risk for multivessel disease. After adjusting for treatment with beta-blockers, heart rate < 94 beats/min, ECG signs of ischemia, and abnormalities on baseline echocardiogram with remote asynergies during dobutamine testing were independent predictors of multivessel disease in the multivariate analysis (probability > 90% when at least two factors were present). CONCLUSION: A heart rate < 94 beats/min at peak dose of dobutamine or after atropine, ECG signs of ischemia, and the presence of abnormalities on echocardiogram at rest with remote asynergies during dobutamine stress testing were independent predictive factors of multivessel coronary artery disease.     

Limited myocardial contractile reserve and chronotropic incompetence in patients with chronic Chagas' disease: assessment by dobutamine stress echocardiography

OBJECTIVES: To determine whether dobutamine stimulation in patients with Chagas' disease may uncover abnormal contractile responses as seen in ischemic myocardium. BACKGROUND: Segmental left ventricular (LV) dysfunction in the absence of coronary atherosclerosis is frequently seen in patients with chronic Chagas' heart disease. Myocardial ischemia and coronary microcirculation abnormalities have been found in animal models and in humans with Chagas' disease. In addition, chagasic sera may contain autoantibodies against human beta-adrenergic receptors. METHODS: Two groups of patients with Chagas' disease were studied by echocardiography: group 1 (n = 12) without and group 2 (n = 14) with LV segmental wall motion abnormalities (mostly apical aneurysm). Ten normal subjects served as control subjects. We performed qualitative assessment of wall motion and quantitative evaluation of LV cavity under baseline conditions and after dobutamine stimulation. RESULTS: Patients with Chagas' disease exhibited a blunted inotropic and chronotropic response to dobutamine stimulation. After dobutamine, fractional area change in Chagas' group 1 (54.7+/-6.6%; SD) and in group 2 (35.1+/-12.1%) were significantly lower than control group (66.7+/-2.5%; p < 0.001). In addition, in 6 of 14 group 2 patients, dobutamine induced a biphasic response with improvement at low dose and deterioration at peak dose, as seen in patients with coronary artery disease. Although the three groups had similar basal mean heart rates and attained a similar mean peak dobutamine doses, both groups of patients with Chagas' disease had a significantly blunted mean heart rate effect after dobutamine (p < 0.0001). CONCLUSIONS: Thus, dobutamine stimulation unmasks a chronotropic incompetence and a blunted myocardial contractile response in chagasic patients, even in those with no overt manifestation of heart disease.