Speaking, Stress, and the Induction of Myocardial Ischemia

To the Editor: Rozanski et al. (April 21 issue)¹ conclude that “mental stress” produced myocardial ischemia, often asymptomatic, in patients with coronary artery disease. The term “mental stress” is used in the title of their paper as well as 42 times in the text, and the term “mental task” appears 14 times. However, all the tasks performed apparently required some verbal response. The authors suggest that simulated public speaking produced the greatest ischemic changes because it caused the most mental stress, despite the fact that the subjects themselves did not rate this task as more stressful than others. There was.