Lilian Hamity, Franco Ramello, Leandro Marani, Alejandro Moyano, Eduardo Moreyra, Luis E. Alday
DOI: 10.4236/health.2010.24044   PDF    HTML     5,360 Downloads   9,982 Views   Citations

Abstract

Objectives: To establish the prevalence, clinical features, and outcomes of the recently recog- nized stress cardiomyopathy whose physiopathology is still not completely clarified. Material and methods: The prevalence and clinical findings of stress cardiomyopathy were assessed in a group of 378 patients undergoing cinecoronariography for acute coronary syndromes dur- ing a 7-year period. The inclusion criteria were severe chest pain, ischemic electrocardiogra- phic changes, reversible left ventricular dys- hypokinesia, and normal coronary arteries. Eight patients, 7 female (2.1% of all patients and 5.0% of the women), with a mean age of 65.3 ± 8.5 years fulfilled the requirements. Results: The precipitating factor was severe stress in all of them. Cardiac enzymes were slightly raised. There was apical left ventricular dyskinesia in 6 patients, midventricular in another, and diffuse hypokinesia in the remaining. One patient showed moderate mitral regurgitation. The response to con- ventional treatment and patient outcomes were favorable in all cases with prompt reversal of the left ventricular dyskinesia as assessed by echocardiography. There were 4 recurrences, 2 requiring readmission to hospital, despite continuous treatment with combined alfa and beta adrenergic blockers and calcium antagonists. Conclusions: In our hospital, stress cardiomyo- pathy had a prevalence of 2.1% in all patients with acute coronary syndromes and 5.1% in women and should be considered in their differential diagnosis, especially in middle aged female patients with a history of severe previous stress. There was a favorable outcome but recurrences may occur despite uninterrupted me- dical treatment following discharge.

Keywords

Stress Cardiomyopathy; Takotsubo Syndrome; Myocardial Ischemia; Cardiomyopathy

Share and Cite:

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Dote, K., Sato, H., Tateishi, H., Uchida, T. and Ishihara, M. (1991) Myocardial stunning due to simultaneous multivessel coronary spasms: A review of 5 cases. Journal of Cardiology, 21, 203-214.
[2]	Abe, Y. and Kondo, M. (2003) Apical ballooning of the left ventricle: A distinct entity? Heart, 89, 974-976.
[3]	Bybee, K.A., Kara, T., Prasad, A., Lerman, A., Barsness, G.W., Wright, S., et al. (2004) Systematic review: Transient left ventricular apical ballooning: A syndrome that mimics ST-segment elevation myocardial infarction. Annals of Internal Medicine, 141, 858-865.
[4]	Brandspiegel, H.Z., Marinchak, R.A., Rials, S.J. and Kowey, P.R. (1998) A broken heart. Circulation, 98, 1349.
[5]	Pavin, D., Le Breton, H. and Daubert, C. (1997) Human stress cardiomyopathy mimicking acute myocardial syndrome. Heart, 78, 509-511.
[6]	Sharkey, S.W., Lesser, J.R., Zenovich, A.G., Maron, M.S., Lindberg, J., Longe, T.F., et al. (2005) Acute and reverse- ble cardiomyopathy provoked by stress in women from the United States. Circulation, 111, 472-479.
[7]	Lyon, A.R., Rees, P.S.C., Prasad, S., Poole-Wilson, P.A. and Harding, S.E. (2008) Stress (Takotsubo) cardio- myopathy—a novel pathophysiological hypothesis to explain cathecolamine—induced myocardial stunning. Nature Clinical Practice Cardiovascular Medicine, 5, 22-29.
[8]	Juri, J.E., Smith, F.J., Bahamonde, L.A., De Rosa, A. And Salzberg, S. (2005) Discinesia apical transitoria. Rev Argent Cardiol, 73, 64-67.
[9]	Gianni, M., Dentali, F., Grandi, A.M., Sumner, G., Hiralal, R. and Lonn, E. (2006) Apical ballooning syndrome or Takotsubo cardiomyopathy: A systematic review. Euro- pean Heart Journal, 27, 1523-1529.
[10]	Elesber, A.A., Prasad, A., Lennon, R.J., Wright, R.S., Ler- man, A. and Rihal, C.S. (2007) Four-year recurrence rate and prognosis of the apical ballooning syndrome. Journal of the American College of Cardiology, 50, 448-452.
[11]	Tsuchihashi, K., Ueshima, K., Uchida, T., Oh-mura, N., Kimura, K., Owa, M., et al. (2001) Transient left ven- tricular apical ballooning without coronary artery stenosis: A novel heart syndrome mimicking acute myocardial in- farction. Journal of the American College of Cardiology, 38, 11-18.
[12]	Bybee, K.A. and Prasad, A. (2008) Stress-related cardiomyopathy syndromes. Circulation, 118, 397-409.
[13]	Parodi, G., Del Pace, S., Salvadori, C., Carrabba, N., Olivotto, I. and Gensini, G.F. (2007) Tuscani registry of Tako-Tsubo cardiomyopathy: Left ventricular apical bal- looning syndrome as a novel cause of acute mitral regur- gitation. Journal of the American College of Cardiology, 50, 647-649.
[14]	Elian, D., Osherou, A., Matetzky, S., Hod, H., Guetta, V., Feinberg, M.S., et al. (2006) Left ventricular apical ballooning syndrome: Not an uncommon variant of acute myocardial infarction in women. Clinical Cardiology, 29, 9-13.
[15]	Akashi, Y.J., Goldstein, D.S., Barbaro, G. and Ueyama, T. (2008) Takotsubo cardiomyopathy: A new form of acute reversible heart failure. Circulation, 118, 2754-2762.
[16]	Nef, H.M., Mollmann, H. and Elsasser, A. (2007) Tako- tsubo cardiomyopathy (apical ballooning). Heart, 93, 1309-1315.
[17]	Wittstein, I.S., Thiemann, D.R., Lima, J.A.C., Baughman, K.L., Shulman, S.P., Gerstenblith, G., et al. (2005) Neu- rohumoral features of myocardial stunning due to sudden emotional stress. The New England Journal of Medicine, 352, 539-548.
[18]	Hurst, R.T., Askew, J.W., Reuss, C.S., Lee, R.W., Swen- ney, J.P., Fortuin, F.D., et al. (2006) Transient midven- tricular ballooning: A new variant. Journal of the Ameri- can College of Cardiology, 48, 579-583
[19]	Sanchez-Recalde, A., Costero, O., Oliver, J.M., Iborra, C., Ruiz, E. and Sobrino, J.A. (2006) Pheochromocytoma- related cardiomyopathy inverted takotsubo contractile pattern. Circulation, 113, e738-e739.
[20]	Khallafi, H., Chacko, V., Varveralis, N. and Elmi, F. (2008) “Broken heart syndrome”: Catecholamine surge or aborted myocardial infarction? The Journal of Invasive Cardiology, 20, e9-e13
[21]	Kurisu, S., Inohue, I., Kawagoe, T., Ishihara, M., Shimatani, I., Nishioka, K., et al. (2003) Myocardial perfusion and fatty acid metabolism in patients with tako-tsubo-like left ventricular dysfunction. Journal of the American College of Cardiology, 41, 743-748.
[22]	Bybee, K.A., Murphy, J., Wright, R.S., Prasad, A., Rihal, C.S. and Chareontaitawee, P. (2006) Acute impairment of regional myocardial glucose utilization in the apical ballooning (Takotsubo) syndrome. Journal of Nuclear Cardiology, 13(2), 244-250.
[23]	Villareal, R.P., Achari, A., Wilansky, S. and Wilson, J.M.l. (2001) Anteroapical stunning and left ventricular outflow tract obstruction. Mayo Clinic Proceeding, 76, 79-83..,