Document Detail


Neurohumoral features of myocardial stunning due to sudden emotional stress.
MedLine Citation:
PMID:  15703419     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Reversible left ventricular dysfunction precipitated by emotional stress has been reported, but the mechanism remains unknown. METHODS: We evaluated 19 patients who presented with left ventricular dysfunction after sudden emotional stress. All patients underwent coronary angiography and serial echocardiography; five underwent endomyocardial biopsy. Plasma catecholamine levels in 13 patients with stress-related myocardial dysfunction were compared with those in 7 patients with Killip class III myocardial infarction. RESULTS: The median age of patients with stress-induced cardiomyopathy was 63 years, and 95 percent were women. Clinical presentations included chest pain, pulmonary edema, and cardiogenic shock. Diffuse T-wave inversion and a prolonged QT interval occurred in most patients. Seventeen patients had mildly elevated serum troponin I levels, but only 1 of 19 had angiographic evidence of clinically significant coronary disease. Severe left ventricular dysfunction was present on admission (median ejection fraction, 0.20; interquartile range, 0.15 to 0.30) and rapidly resolved in all patients (ejection fraction at two to four weeks, 0.60; interquartile range, 0.55 to 0.65; P<0.001). Endomyocardial biopsy showed mononuclear infiltrates and contraction-band necrosis. Plasma catecholamine levels at presentation were markedly higher among patients with stress-induced cardiomyopathy than among those with Killip class III myocardial infarction (median epinephrine level, 1264 pg per milliliter [interquartile range, 916 to 1374] vs. 376 pg per milliliter [interquartile range, 275 to 476]; norepinephrine level, 2284 pg per milliliter [interquartile range, 1709 to 2910] vs. 1100 pg per milliliter [interquartile range, 914 to 1320]; and dopamine level, 111 pg per milliliter [interquartile range, 106 to 146] vs. 61 pg per milliliter [interquartile range, 46 to 77]; P<0.005 for all comparisons). CONCLUSIONS: Emotional stress can precipitate severe, reversible left ventricular dysfunction in patients without coronary disease. Exaggerated sympathetic stimulation is probably central to the cause of this syndrome.
Authors:
Ilan S Wittstein; David R Thiemann; Joao A C Lima; Kenneth L Baughman; Steven P Schulman; Gary Gerstenblith; Katherine C Wu; Jeffrey J Rade; Trinity J Bivalacqua; Hunter C Champion
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  352     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2005 Feb 
Date Detail:
Created Date:  2005-02-10     Completed Date:  2005-02-15     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  539-48     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2005 Massachusetts Medical Society.
Affiliation:
Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA. iwittste@jhmi.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Catecholamines / blood*
Chest Pain / etiology
Creatine Kinase / blood
Diagnosis, Differential
Female
Humans
Male
Middle Aged
Myocardial Infarction / blood,  diagnosis
Myocardial Stunning / blood,  diagnosis,  physiopathology,  psychology*
Myocardium / pathology
Neuropeptides / blood*
Serotonin / blood
Stress, Psychological / complications*,  physiopathology
Troponin I / blood
Chemical
Reg. No./Substance:
0/Catecholamines; 0/Neuropeptides; 0/Troponin I; 50-67-9/Serotonin; EC 2.7.3.2/Creatine Kinase
Comments/Corrections
Comment In:
N Engl J Med. 2005 May 5;352(18):1923-5; author reply 1923-5   [PMID:  15877318 ]
N Engl J Med. 2005 May 5;352(18):1923-5; author reply 1923-5   [PMID:  15877319 ]
N Engl J Med. 2005 May 5;352(18):1923-5; author reply 1923-5   [PMID:  15872209 ]

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