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Background  Negative emotions have been linked to ischemic heart disease, but existing research typically involves self-report methods and little is known about non-verbal facial emotion expression. The role of ischemia and anginal symptoms in emotion expression was examined.    Methods  Patients undergoing cardiac stress testing (CST) using bicycle exercise or adenosine with myocardial perfusion imaging were included ( N  = 256, mean age 66.8 ± 8.7 year., 43% women). Video images and emotion expression (sadness, anxiety, anger, and happiness) were analyzed at baseline, initial CST , maximal CST, recovery. Nuclear images were evaluated using SPECT.    Results  Ischemia ( N  = 89; 35%) was associated with higher levels of sadness ( p  = .017,  d  = 0.34) and lower happiness ( p  = .015,  d  = 0.30). During recovery, patients with both ischemia and anginal symptoms had the highest sadness expression ( F  (3,254) = 3.67,  p  = .013, eta 2  = 0.042) and the lowest happiness expression ( F  (3, 254) = 4.19,  p  = .006, eta 2  = .048).    Conclusion  Sadness and reduced happiness were more common in patients with ischemia. Also, anginal symptoms were associated with more negative emotions.

Facial Expressions of Emotions During Pharmacological and Exercise Stress Testing: the Role of Myocardial Ischemia and Cardiac Symptoms