Journal ArticleDOI
Neurohumoral Features of Myocardial Stunning Due to Sudden Emotional Stress
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 +9 more
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TLDR
Emotional stress can precipitate severe, reversible left ventricular dysfunction in patients without coronary disease andaggerated sympathetic stimulation is probably central to the cause of this syndrome.Abstract:
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 stressinduced 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.read more
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Association between elevated plasma norepinephrine levels and cardiac wall motion abnormality in poor-grade subarachnoid hemorrhage patients
Keiko Sugimoto,Joji Inamasu,Yoko Kato,Yasuhiro Yamada,Tsukasa Ganaha,Motoki Oheda,Natsuki Hattori,Eiichi Watanabe,Yukio Ozaki,Yuichi Hirose +9 more
TL;DR: Investigation of relationship between WMA and plasma catecholamine levels in poor-grade SAH patients in the acute phase revealed that increased plasma norepinephrine levels were predictive of WMA, although age, female sex, and grade V SAH were not.
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Takotsubo cardiomyopathy: definition and clinical profile.
TL;DR: The defining features and clinical profile of TTC are reviewed, including wall-motion abnormalities that extend beyond the territory of a single epicardial coronary artery, and the absence of obstructive coronary lesions.
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One-year results of the randomized, controlled, short-term psychotherapy in acute myocardial infarction (STEP-IN-AMI) trial
Adriana Roncella,Christian Pristipino,Cinzia Cianfrocca,Silvia Scorza,Vincenzo Pasceri,Francesco Pelliccia,Johan Denollet,Johan Denollet,Susanne S. Pedersen,Susanne S. Pedersen,Giulio Speciale +10 more
TL;DR: Adding STP to cardiological therapy improves cardiological symptoms, quality of life, and psychological and medical outcomes one year post AMI, while reducing the need for re-hospitalizations.
Journal ArticleDOI
Takotsubo Syndrome: Pathophysiology, Emerging Concepts and Clinical Implications
TL;DR: There is a lack of evidence-based interventions to treat the acute episode, to avoid recurrences, and to prevent major adverse cardiovascular events and the need for further research to gain a better understanding of the underlying pathophysiology to inform appropriate randomized controlled trials of interventions targeting the causative pathways.
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The syndrome of excited delirium.
TL;DR: The main goal of the autopsy of deaths suspected to be due to EDS is to identify (or exclude) intervening diseases or injuries sufficient to explain the death in the context of the investigated circumstances.
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Margaret M. Redfield,Richard J. Rodeheffer,Steven J. Jacobsen,Douglas W. Mahoney,Kent R. Bailey,John C. Burnett +5 more
TL;DR: Investigation of the effects of age and gender on plasma brain natriuretic peptide concentration in a population-based study confirmed that discriminatory values for BNP for detection of reduced ejection fraction were higher in women and older persons and were different between the two assays.
Journal ArticleDOI
Molecular and Cellular Mechanisms of Myocardial Stunning
Roberto Bolli,Eduardo Marbán +1 more
TL;DR: An important implication of the phenomenon of myocardial stunning is that so-called chronic hibernation may in fact be the result of repetitive episodes of stunning, which have a cumulative effect and cause protracted postischemic dysfunction.
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Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction.
Satoshi Kurisu,Hikaru Sato,Takuji Kawagoe,Masaharu Ishihara,Yuji Shimatani,Kenji Nishioka,Yasuyuki Kono,Takashi Umemura,Suji Nakamura +8 more
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