Anxiety and coronary heart disease in midlife.

The effects of anxiety on cardiovascular functioning are primarily beneficial. A well-known relationship exists between anxiety and performance. Up to a certain level, the higher the anxiety, the better the performance. It is when anxiety reaches an extreme level, plus when other emotions, such as hostility and depression, are also present that anxiety exerts a negative influence on cardiovascular health. Physiologic evidence of the negative effects of extreme anxiety in persons with coronary heart disease has, until recently, been determined by symptomatic and/or electrocardiographic indications of myocardial ischemia. New imaging techniques now make it possible to examine moment-to-moment variations in emotional state and cardiac function. From these new studies, we now know that episodes of myocardial ischemia secondary to psychologic stimuli are far more common than previously thought. Also, myocardial ischemia secondary to psychologic stress usually occurs at low heart rates and without chest pain.