This is an amended application which is a continuation study on the relationship of pain perception and myocardial ischemia during exercise and psychological stressful challenge. The overall hypothesis to be tested states that opioid peptide responses to stress are responsible for decreasing pain perception and resulting in silent myocardial ischemia. The proposed four year study will assess 60 subjects with a positive history of coronary artery disease (CAD) and compare findings with 40 age, sex, race, and blood pressure-matched healthy individuals who do not have coronary artery disease. The study will have a randomized double-blind placebo-controlled crossover design. Each patient will be studied over a 28-day study period, with a testing period in the first and last week of this study period in which the patient will be receiving placebo treatment or treatment with naltrexone, (an opioid antagonist). Each of the CAD subjects will receive 48-hour ambulatory Holter monitoring to track ischemic episodes. All subjects will receive exercise and psychological stress testing, and thermal and forearm ischemic pain testing at the beginning and end of the study period. The pain assessments will be performed prior to and following the stressors.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
7R01HL047477-07
Application #
6030631
Study Section
Special Emphasis Panel (ZRG2-HUD-3 (02))
Project Start
1992-02-15
Project End
2001-06-30
Budget Start
1999-07-01
Budget End
2000-06-30
Support Year
7
Fiscal Year
1999
Total Cost
Indirect Cost
Name
University of Florida
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
073130411
City
Gainesville
State
FL
Country
United States
Zip Code
32611
Kim, Chin K; Bartholomew, Beth A; Mastin, Suzanne T et al. (2003) Detection and reproducibility of mental stress-induced myocardial ischemia with Tc-99m sestamibi SPECT in normal and coronary artery disease populations. J Nucl Cardiol 10:56-62
Sheffield, D; Biles, P L; Orom, H et al. (2000) Race and sex differences in cutaneous pain perception. Psychosom Med 62:517-23
Sheffield, D; Kirby, D S; Biles, P L et al. (1999) Comparison of perception of angina pectoris during exercise testing in African-Americans versus Caucasians. Am J Cardiol 83:106-8, A8
Go, B M; Sheffield, D; Krittayaphong, R et al. (1997) Association of systolic blood pressure at time of myocardial ischemia with angina pectoris during exercise testing. Am J Cardiol 79:954-6
Krittayaphong, R; Cascio, W E; Light, K C et al. (1997) Heart rate variability in patients with coronary artery disease: differences in patients with higher and lower depression scores. Psychosom Med 59:231-5
Krittayaphong, R; Sheps, D S (1996) Relation between blood pressure at rest and perception of angina pectoris during exercise testing. Am J Cardiol 77:1224-6
Krittayaphong, R; Biles, P L; Christy, C G et al. (1996) Association between angina pectoris and ischemic indexes during exercise testing and ambulatory monitoring. Am J Cardiol 78:266-70
Krittayaphong, R; Light, K C; Golden, R N et al. (1996) Relationship among depression scores, beta-endorphin, and angina pectoris during exercise in patients with coronary artery disease. Clin J Pain 12:126-33
Krittayaphong, R; Light, K C; Biles, P L et al. (1995) Increased heart rate response to laboratory-induced mental stress predicts frequency and duration of daily life ambulatory myocardial ischemia in patients with coronary artery disease. Am J Cardiol 76:657-60
Sheps, D S; Bragdon, E E; Gray 3rd, T F et al. (1992) Relation between systemic hypertension and pain perception. Am J Cardiol 70:3F-5F