When a brain region involved in emotional regulation fires up in response to stress and anxiety, it might provoke angina in patients with heart disease, an imaging study suggests.

High resolution PET imaging of people with coronary artery disease experiencing a mental stressor revealed that those who showed greater inferior frontal lobe activation tended to have more frequent angina at baseline and at two-year follow-up.

To look at how mental stress might affect angina, US researchers recruited 148 patients (mean age 62) who had been diagnosed with stable coronary artery disease.

Angina symptoms were measured at the outset and also two years later using the Seattle Angina Questionnaire’s frequency subscale, which assesses frequency of angina and use of nitroglycerine for chest pain.