Mathew M. Burg, Ph.D. Associate Clinical Professor of Medicine

Stress and Emotion in Coronary Heart Disease

Our interest in the role of stress and emotion in coronary disease has taken two approaches. We have been exploring mental stress provoked ischemia, documenting the phenomenon in naturalistic and laboratory settings. This work has allowed us to identify the anger and stress related behavioral and emotional characteristics of individuals at risk for this phenomenon, as well as the three fold greater risk of acute coronary events for people who experience this phenomenon. Additional work has served to distinguish this form of ischemia from exercise provoked ischemia, both with regard to hemodynamic characteristics and behavioral characteristics. Ongoing research is focused on the role of the central nervous system through the use of PET for the identification of brain centers uniquely activated during mental stress ischemia and the relationship of behavioral and psychological factors to such activation. In addition, the relative importance of vasculature function and processes by which vascular function is dynamically altered (e.g., inflammatory processes, autonomic modulation) are being explored.  We have also been documenting the effects of acute stress and emotions such as anger on pro-arrhythmic processes in patients with implantable cardioverter defibrillators (ICD).  Our findings demonstrate the profound effect that such stressors have on T-wave alternans, and the behavioral factors that contribute to risk for stress induced atrial and ventricular arrhythmias.

A second focus of our work has been on the conduct of behavioral randomized clinical trials to reduce risk in populations with extant CHD.  These trials have as their focus such factors as depression in post-ACS populations and stress reduction in new recipients of implantable cardioverter defibrillators. 


Burg MM, Lespérance F, Rieckmann N, Clemow L, Skotzko C, Davidson KW. Treating persistent depressive symptoms in post-ACS patients:  The Project COPES phase-I randomized controlled trial. Contemp Clin Trials 2007 (in press).

Burg MM, Soufer R. Mental stress-induced myocardial ischemia: moving forward. J Nucl Cardiol 2007;14:308-13.

Lett HS, Blumenthal JA, Babyak MA, Catellier DJ, Carney RM, Berkman LF, Burg MM, Mitchell P, Jaffe AS, Schneiderman N.  Social support and prognosis in patients at increased psychosocial risk recovering from myocardial infarction. Health Psychol 2007;26:418-27.

Dornelas EA, Burg MM. Treatment of depression in patients with coronary artery disease. JAMA 2007;297:1879-80.

Soufer R, Burg MM. The heart-brain interaction during emotionally provoked myocardial ischemia: Implications of cortical hyperactivation in CAD and gender interactions. Cleve Clin J Med 2007;74:S59-62.

Stopper M, Joska T, Burg MM, Batsford WP, McPherson CA, Jain D, Lampert R:  Electrophysiologic characteristics of anger-triggered arrhythmias. Heart Rhythm 2007;4:268-73.

Shah R, Burg MM, Vashist A, Collins D, Liu J, Jadbabaie F, Graeber B, Earley C, Lampert R, Soufer R. C-reactive protein and vulnerability to mental stress-induced myocardial ischemia. Molecular Med 2006;12:269-74.

Carney RM, Howells WB, Blumenthal JA, Freedland KE, Stein PK, Berkman LF, Watkins LL, Czajkowski SM, Steinmeyer B, Hayano J, Domitrovich PP, Burg MM, Jaffe AS.  Heart rate turbulence, depression, and survival after acute myocardial infarction.  Psychosom Med 2007;69:4-9.

Rieckmann N, Kronish IM, Haas D, Gerin W, Chaplin W F, Burg MM, Vorchheimer D, Davidson KW. Persistent depressive symptoms lower aspirin adherence following acute coronary syndromes. Am Heart J 2006;152:922-7.

Mendes de Leon CF, Czajkowski SM, Freedland KE, Bang H, Powell LH, Wu C, Burg MM, DiLillo V, Ironson G, Krumholz HM, Mitchell P, Blumenthal JA, for the ENRICHD investigators. The effect of a psychosocial intervention on quality of life after acute myocardial infarction: The Enhancing Recovery in Coronary Heart Disease (ENRICHD) Clinical Trial. J Cardipulm Rehab 2006;26:9-13.

Burg MM, Czajkowski S, Berkman LF, Barefoot JC, Saab P, Skala J, Huber M, DeLilli V, Taylor CB. Social support and recurrent cardiac events in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) trial. Psychosom Med 2005;67:879-88.

Haas DC, Chaplin WF, Shimbo D, Pickering TG, Burg M, Davidson KW. Hostility is an independent predictor of recurrent coronary heart disease events in men but not women: results from a population based study. Heart 2005;91:1609-10.

Taylor CB, Youngblood ME, Catellier D, Veith RC, Carney RM, Burg MM, Kaufmann P, Shuster J, Mellman T, Blumenthal JA, Krishnan R, Jaffe AS, for the ENRICHD Investigators.  Effects of antidepressant medication on morbidity and mortality in depressed post-MI patients.  Arch Gen Psychiatry 2005;62:792-8.

Powell L, Freedland KE, Catellier D, Burg MM, Bittner V, Calvin J, Downs, D, Flynn K, Woods S. Depression and heart failure in patients with new myocardial infarction.  Am Heart J 2005;149:851-5.

Lampert R, Shusterman V, Burg MM, Lee F, Earley C, Goldberg A, McPherson C, Batsford W, Soufer R. Effects of psychologic stress on repolarization and relationship to autonomic and hemodynamic factors. J Cardiovasc Electrophysiol 2005;16:372-7.

Burg MM, Lampert R, Joska T, Batsford W, Jain D.  Psychological traits and emotion-triggering of ICD shock-terminated arrhythmias.  Psychosomatic Med 2004;66:898-902.

Carney RM, Blumenthal JA, Freedland KE, Youngblood M, Veith RC, Burg MM, Cornell C, Saab PG,  Kaufman P, Czajkowski SM, Jaffe AS. Depression and late mortality after myocardial infarction in the Enhancing Recovery in Coronary heart Disease (ENRICHD) study. Psychosom Med 2004;66:466-74.

Blumenthal JA, Babyak M, Carney R, Huber M, Saab P, Burg MM, Sheps D, Powell L, Taylor CB, Kaufmann P. Exercise and mortality after acute myocardial infarction. Med Sports Sci Ex 2004;36:746-755.

Barefoot JC, Burg MB, Carney RM, Cornell CE, Czajkowski SM, Freedland KE, Hosking JD, Khatri P, Pitula C, Sheps D. Aspects of social support associated with depression at hospitalization and follow-up in cardiac patients. J Cardiopulm Rehab 2003;23:404-12.

Burg MM, Benedetto MC, Soufer R.  Depression and mortality 2 years after coronary artery bypass graft surgery (CABG). Psychosom Med 2003 2003;65:508-510.

Berkman LF, Blumenthal J, Burg M, Carney RM, Catellier D, Cowan MJ, Czajkowski SM, DeBusk R, Hosking J, Jaffe A, Kaufmann PG, Mitchell P, Norman J, Powell LH, Raczynski JM, Schneiderman N, ENRICHD Investigators.  The enhancing recovery in coronary heart disease patients (ENRICHD) study:  The effects of treating depression and low social support on clinical events after myocardial infarction.  JAMA 2003;289:3106-16.

Arrighi JA, Burg MM, Cohen IS, Possick S, Soufer R. Simultaneous Assessment of Myocardial Perfusion and Function During Mental Stress in Patients with Chronic Coronary Artery Disease. J Nucl Cardiol 2003;10:267-74.

Burg MM, Benedetto CM, Rosenberg R, Soufer R. Pre-surgical depression impacts 6-month outcome in patients undergoing coronary artery bypass graft (CABG) surgery. Psychosom Med 2003;65:111-118.

Lampert R, Joska T, Burg, MM, Batsford, WP, McPherson CA, Jain D. Emotional and physical precipitants of ventricular arrhythmia.  Circulation 2002;106:1800-05.

Jain D, Joska T, Lee FA, Burg M, Lampert R, Zaret BA. Day to day reproducibility of mental-stress induced abnormal left ventricular function response in patients with coronary artery disease and its relationship to autonomic activity. J Nucl Cardiol 2001;8:347-55.

Arrighi JA, Burg MM, Cohen I, Pfau S, Caulin-Glaser T, Zaret BL, Soufer R. Myocardial blood flow response to mental stress in normal subjects and patients with chronic coronary artery disease. Lancet 2000;356:310-11.

Lampert R, Jain D, Burg MM, Batsford WP, McPherson CA. Destabilizing effects of mental stress on ventricular arrhythmias in patients with implanted cardioverter-defibrillators. Circulation 2000;101:151-164

Soufer R, Bremner JD, Arrighi JA, Cohen I, Zaret BL, Burg MM, Goldman-Rakic P. Cerebral cortical hyperactivation in response to mental stress in patients with coronary artery disease. Proc Nat Acad Sci 1998;95:6454-6459.

Jain D, Shakir S, Burg MM, Wackers FTh, Soufer R, Zaret BL. Effect of mental stress on left ventricular and peripheral vascular performance in patients with coronary artery disease.  J Am Coll Cardiol 1998;31:1314-1322.

Jain D, Burg MM, Soufer R, Zaret BL. Prognostic implications of mental stress induced silent left ventricular dysfunction in patients with stable angina pectoris.  Am J Cardiol 1995;76:31-35.

Burg MM, Jain D, Soufer R, Kerns RD, Zaret BL. Role of behavioral and psychological factors in mental stress induced silent left ventricular dysfunction in coronary artery disease. J Am Coll Cardiol 1993;22:440-448.

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Last modified:Wednesday, 09-Apr-2008 12:29:27 EDT (PL).