Acute and reversible cardiomyopathy provoked by stress in women from the United States
A clinical entity characterized by acute but rapidly reversible left ventricular (LV) systolic dysfunction and triggered by psychological stress is emerging, with reports largely confined to Japan. Over a 32-month period, 22 consecutive patients with this novel cardiomyopathy were prospectively iden...
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Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2005-02, Vol.111 (4), p.472-479 |
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creator | SHARKEY, Scott W LESSER, John R ZENOVICH, Andrey G MARON, Martin S LINDBERG, Jana LONGE, Terrence F MARON, Barry J |
description | A clinical entity characterized by acute but rapidly reversible left ventricular (LV) systolic dysfunction and triggered by psychological stress is emerging, with reports largely confined to Japan.
Over a 32-month period, 22 consecutive patients with this novel cardiomyopathy were prospectively identified within a community-based practice in the Minneapolis-St. Paul, Minn, area. All patients were women aged 32 to 89 years old (mean 65+/-13 years); 21 (96%) were > or =50 years of age. The syndrome is characterized by (1) acute substernal chest pain with ST-segment elevation and/or T-wave inversion; (2) absence of significant coronary arterial narrowing by angiography; (3) systolic dysfunction (ejection fraction 29+/-9%), with abnormal wall motion of the mid and distal LV, ie, "apical ballooning"; and (4) profound psychological stress (eg, death of relatives, domestic abuse, arguments, catastrophic medical diagnoses, devastating financial or gambling losses) immediately preceding and triggering the cardiac events. A significant proportion of patients (37%) had hemodynamic compromise and required vasopressor agents and intra-aortic balloon counterpulsation. Each patient survived with normalized ejection fraction (63+/-6%; P |
doi_str_mv | 10.1161/01.cir.0000153801.51470.eb |
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Over a 32-month period, 22 consecutive patients with this novel cardiomyopathy were prospectively identified within a community-based practice in the Minneapolis-St. Paul, Minn, area. All patients were women aged 32 to 89 years old (mean 65+/-13 years); 21 (96%) were > or =50 years of age. The syndrome is characterized by (1) acute substernal chest pain with ST-segment elevation and/or T-wave inversion; (2) absence of significant coronary arterial narrowing by angiography; (3) systolic dysfunction (ejection fraction 29+/-9%), with abnormal wall motion of the mid and distal LV, ie, "apical ballooning"; and (4) profound psychological stress (eg, death of relatives, domestic abuse, arguments, catastrophic medical diagnoses, devastating financial or gambling losses) immediately preceding and triggering the cardiac events. A significant proportion of patients (37%) had hemodynamic compromise and required vasopressor agents and intra-aortic balloon counterpulsation. Each patient survived with normalized ejection fraction (63+/-6%; P<0.001) and rapid restoration to previous functional cardiovascular status within 6+/-3 days. In 95%, MRI identified diffusely distributed segmental wall-motion abnormalities that encompassed LV myocardium in multiple coronary arterial vascular territories.
A reversible cardiomyopathy triggered by psychologically stressful events occurs in older women and may mimic evolving acute myocardial infarction or coronary syndrome. This condition is characterized by a distinctive form of systolic dysfunction that predominantly affects the distal LV chamber and a favorable outcome with appropriate medical therapy.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/01.cir.0000153801.51470.eb</identifier><identifier>PMID: 15687136</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Arterial hypertension. Arterial hypotension ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Cardiomyopathy, Dilated - diagnosis ; Cardiomyopathy, Dilated - epidemiology ; Cardiomyopathy, Dilated - etiology ; Chest Pain - etiology ; Clinical manifestations. Epidemiology. Investigative techniques. Etiology ; Cohort Studies ; Coronary Angiography ; Dermatology ; Diagnosis, Differential ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Electrocardiography ; Female ; Heart Ventricles - pathology ; Humans ; Magnetic Resonance Imaging ; Medical sciences ; Middle Aged ; Minnesota - epidemiology ; Myocardial Infarction - diagnosis ; Prognosis ; Prospective Studies ; Skin involvement in other diseases. Miscellaneous. General aspects ; Stress, Psychological - complications ; Stress, Psychological - physiopathology ; Stroke Volume ; Syndrome ; Troponin I - blood ; Troponin T - blood ; Ventricular Dysfunction, Left - diagnosis ; Ventricular Dysfunction, Left - epidemiology ; Ventricular Dysfunction, Left - etiology</subject><ispartof>Circulation (New York, N.Y.), 2005-02, Vol.111 (4), p.472-479</ispartof><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c506t-1f0f184d0719dd4ab1800837f00707de5f66059d83206f715e21e9809cf46f9f3</citedby><cites>FETCH-LOGICAL-c506t-1f0f184d0719dd4ab1800837f00707de5f66059d83206f715e21e9809cf46f9f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16603471$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15687136$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>SHARKEY, Scott W</creatorcontrib><creatorcontrib>LESSER, John R</creatorcontrib><creatorcontrib>ZENOVICH, Andrey G</creatorcontrib><creatorcontrib>MARON, Martin S</creatorcontrib><creatorcontrib>LINDBERG, Jana</creatorcontrib><creatorcontrib>LONGE, Terrence F</creatorcontrib><creatorcontrib>MARON, Barry J</creatorcontrib><title>Acute and reversible cardiomyopathy provoked by stress in women from the United States</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>A clinical entity characterized by acute but rapidly reversible left ventricular (LV) systolic dysfunction and triggered by psychological stress is emerging, with reports largely confined to Japan.
Over a 32-month period, 22 consecutive patients with this novel cardiomyopathy were prospectively identified within a community-based practice in the Minneapolis-St. Paul, Minn, area. All patients were women aged 32 to 89 years old (mean 65+/-13 years); 21 (96%) were > or =50 years of age. The syndrome is characterized by (1) acute substernal chest pain with ST-segment elevation and/or T-wave inversion; (2) absence of significant coronary arterial narrowing by angiography; (3) systolic dysfunction (ejection fraction 29+/-9%), with abnormal wall motion of the mid and distal LV, ie, "apical ballooning"; and (4) profound psychological stress (eg, death of relatives, domestic abuse, arguments, catastrophic medical diagnoses, devastating financial or gambling losses) immediately preceding and triggering the cardiac events. A significant proportion of patients (37%) had hemodynamic compromise and required vasopressor agents and intra-aortic balloon counterpulsation. Each patient survived with normalized ejection fraction (63+/-6%; P<0.001) and rapid restoration to previous functional cardiovascular status within 6+/-3 days. In 95%, MRI identified diffusely distributed segmental wall-motion abnormalities that encompassed LV myocardium in multiple coronary arterial vascular territories.
A reversible cardiomyopathy triggered by psychologically stressful events occurs in older women and may mimic evolving acute myocardial infarction or coronary syndrome. This condition is characterized by a distinctive form of systolic dysfunction that predominantly affects the distal LV chamber and a favorable outcome with appropriate medical therapy.</description><subject>Acute Disease</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arterial hypertension. Arterial hypotension</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Cardiomyopathy, Dilated - diagnosis</subject><subject>Cardiomyopathy, Dilated - epidemiology</subject><subject>Cardiomyopathy, Dilated - etiology</subject><subject>Chest Pain - etiology</subject><subject>Clinical manifestations. Epidemiology. Investigative techniques. Etiology</subject><subject>Cohort Studies</subject><subject>Coronary Angiography</subject><subject>Dermatology</subject><subject>Diagnosis, Differential</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Heart Ventricles - pathology</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Minnesota - epidemiology</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Skin involvement in other diseases. Miscellaneous. General aspects</subject><subject>Stress, Psychological - complications</subject><subject>Stress, Psychological - physiopathology</subject><subject>Stroke Volume</subject><subject>Syndrome</subject><subject>Troponin I - blood</subject><subject>Troponin T - blood</subject><subject>Ventricular Dysfunction, Left - diagnosis</subject><subject>Ventricular Dysfunction, Left - epidemiology</subject><subject>Ventricular Dysfunction, Left - etiology</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkNtLHDEUxoO06Hr5FyQI9W22OZPbTN90sVYQCq36GjLJCU6dyzbJKvvfN9aFPS-HD37fuXyEXABbAij4ymDp-rhkpUDypkgJQrMldgdkAbIWlZC8_UQWBWgrzev6iByn9KdIxbU8JEcgVaOBqwV5unKbjNROnkZ8xZj6bkDqbPT9PG7ntc3PW7qO8-v8gp52W5pyxJRoP9G3ecSJhjiPND8jfZz6XJDf2WZMp-RzsEPCs10_IY_fbx5WP6r7n7d3q6v7ykmmcgWBBWiEZxpa74XtoGGs4Towppn2KINSTLa-4TVTQYPEGrBtWOuCUKEN_IRcfswtJ_7dYMpm7JPDYbATzptklOYtF0IX8NsH6OKcUsRg1rEfbdwaYOY9VcPArO5-mX2q5n-q5ua6mM93WzbdiH5v3cVYgC87wCZnhxDt5Pq058oXXBTyHzr7gMM</recordid><startdate>20050201</startdate><enddate>20050201</enddate><creator>SHARKEY, Scott W</creator><creator>LESSER, John R</creator><creator>ZENOVICH, Andrey G</creator><creator>MARON, Martin S</creator><creator>LINDBERG, Jana</creator><creator>LONGE, Terrence F</creator><creator>MARON, Barry J</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20050201</creationdate><title>Acute and reversible cardiomyopathy provoked by stress in women from the United States</title><author>SHARKEY, Scott W ; LESSER, John R ; ZENOVICH, Andrey G ; MARON, Martin S ; LINDBERG, Jana ; LONGE, Terrence F ; MARON, Barry J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c506t-1f0f184d0719dd4ab1800837f00707de5f66059d83206f715e21e9809cf46f9f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Acute Disease</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Arterial hypertension. Arterial hypotension</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Cardiomyopathy, Dilated - diagnosis</topic><topic>Cardiomyopathy, Dilated - epidemiology</topic><topic>Cardiomyopathy, Dilated - etiology</topic><topic>Chest Pain - etiology</topic><topic>Clinical manifestations. Epidemiology. Investigative techniques. Etiology</topic><topic>Cohort Studies</topic><topic>Coronary Angiography</topic><topic>Dermatology</topic><topic>Diagnosis, Differential</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Heart Ventricles - pathology</topic><topic>Humans</topic><topic>Magnetic Resonance Imaging</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Minnesota - epidemiology</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Skin involvement in other diseases. Miscellaneous. General aspects</topic><topic>Stress, Psychological - complications</topic><topic>Stress, Psychological - physiopathology</topic><topic>Stroke Volume</topic><topic>Syndrome</topic><topic>Troponin I - blood</topic><topic>Troponin T - blood</topic><topic>Ventricular Dysfunction, Left - diagnosis</topic><topic>Ventricular Dysfunction, Left - epidemiology</topic><topic>Ventricular Dysfunction, Left - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>SHARKEY, Scott W</creatorcontrib><creatorcontrib>LESSER, John R</creatorcontrib><creatorcontrib>ZENOVICH, Andrey G</creatorcontrib><creatorcontrib>MARON, Martin S</creatorcontrib><creatorcontrib>LINDBERG, Jana</creatorcontrib><creatorcontrib>LONGE, Terrence F</creatorcontrib><creatorcontrib>MARON, Barry J</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>SHARKEY, Scott W</au><au>LESSER, John R</au><au>ZENOVICH, Andrey G</au><au>MARON, Martin S</au><au>LINDBERG, Jana</au><au>LONGE, Terrence F</au><au>MARON, Barry J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Acute and reversible cardiomyopathy provoked by stress in women from the United States</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2005-02-01</date><risdate>2005</risdate><volume>111</volume><issue>4</issue><spage>472</spage><epage>479</epage><pages>472-479</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>A clinical entity characterized by acute but rapidly reversible left ventricular (LV) systolic dysfunction and triggered by psychological stress is emerging, with reports largely confined to Japan.
Over a 32-month period, 22 consecutive patients with this novel cardiomyopathy were prospectively identified within a community-based practice in the Minneapolis-St. Paul, Minn, area. All patients were women aged 32 to 89 years old (mean 65+/-13 years); 21 (96%) were > or =50 years of age. The syndrome is characterized by (1) acute substernal chest pain with ST-segment elevation and/or T-wave inversion; (2) absence of significant coronary arterial narrowing by angiography; (3) systolic dysfunction (ejection fraction 29+/-9%), with abnormal wall motion of the mid and distal LV, ie, "apical ballooning"; and (4) profound psychological stress (eg, death of relatives, domestic abuse, arguments, catastrophic medical diagnoses, devastating financial or gambling losses) immediately preceding and triggering the cardiac events. A significant proportion of patients (37%) had hemodynamic compromise and required vasopressor agents and intra-aortic balloon counterpulsation. Each patient survived with normalized ejection fraction (63+/-6%; P<0.001) and rapid restoration to previous functional cardiovascular status within 6+/-3 days. In 95%, MRI identified diffusely distributed segmental wall-motion abnormalities that encompassed LV myocardium in multiple coronary arterial vascular territories.
A reversible cardiomyopathy triggered by psychologically stressful events occurs in older women and may mimic evolving acute myocardial infarction or coronary syndrome. This condition is characterized by a distinctive form of systolic dysfunction that predominantly affects the distal LV chamber and a favorable outcome with appropriate medical therapy.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>15687136</pmid><doi>10.1161/01.cir.0000153801.51470.eb</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Acute Disease Adult Aged Aged, 80 and over Arterial hypertension. Arterial hypotension Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Cardiomyopathy, Dilated - diagnosis Cardiomyopathy, Dilated - epidemiology Cardiomyopathy, Dilated - etiology Chest Pain - etiology Clinical manifestations. Epidemiology. Investigative techniques. Etiology Cohort Studies Coronary Angiography Dermatology Diagnosis, Differential Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Electrocardiography Female Heart Ventricles - pathology Humans Magnetic Resonance Imaging Medical sciences Middle Aged Minnesota - epidemiology Myocardial Infarction - diagnosis Prognosis Prospective Studies Skin involvement in other diseases. Miscellaneous. General aspects Stress, Psychological - complications Stress, Psychological - physiopathology Stroke Volume Syndrome Troponin I - blood Troponin T - blood Ventricular Dysfunction, Left - diagnosis Ventricular Dysfunction, Left - epidemiology Ventricular Dysfunction, Left - etiology |
title | Acute and reversible cardiomyopathy provoked by stress in women from the United States |
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