| Neurohumoral features of myocardial stunning due to sudden emotional stress. | |
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MedLine Citation:
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PMID: 15703419 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The New England journal of medicine Volume: 352 ISSN: 1533-4406 ISO Abbreviation: N. Engl. J. Med. Publication Date: 2005 Feb |
Date Detail:
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Created Date: 2005-02-10 Completed Date: 2005-02-15 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0255562 Medline TA: N Engl J Med Country: United States |
Other Details:
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Languages: eng Pagination: 539-48 Citation Subset: AIM; IM |
Copyright Information:
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Copyright 2005 Massachusetts Medical Society. |
Affiliation:
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Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA. iwittste@jhmi.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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0/Catecholamines; 0/Neuropeptides; 0/Troponin I; 50-67-9/Serotonin; EC 2.7.3.2/Creatine Kinase |
| Comments/Corrections | |
Comment In:
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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 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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