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
Citations
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Pharmacogenomics of the heptahelical receptor regulators G-protein-coupled receptor kinases and arrestins: the known and the unknown
TL;DR: What is known so far in this evolving field of GRK/Arr pharmacogenomics is discussed, as well as important areas likely to produce invaluable information in the future are highlighted.
Journal ArticleDOI
A single pathophysiological pathway in Takotsubo cardiomyopathy: Catecholaminergic stress.
Elisabeth Coupez,Romain Eschalier,Bruno Pereira,Romain Pierrard,Géraud Souteyrand,Guillaume Clerfond,Bernard Citron,Jean-René Lusson,Nicolas Mansencal,Pascal Motreff +9 more
TL;DR: Whatever the trigger, the common denominator in TTC is catecholaminergic stress, and the various contexts all have a similarly excellent cardiovascular prognosis if treated early.
Journal ArticleDOI
2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain
TL;DR: A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and non-randomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports as mentioned in this paper .
Journal ArticleDOI
Heart-brain interactions in mental stress-induced myocardial ischemia.
TL;DR: A biobehavioral model in which cognitive stress is transduced in the brain is reviewed, which results in various biologic processes that culminate in the perturbation of flow and function of the heart.
Journal ArticleDOI
The Sympathetic Nervous System in the Pathogenesis of Takotsubo Syndrome
TL;DR: Risk factors that increase sympathetic tone and/or catecholamine sensitivity may render individuals particularly susceptible to takotsubo syndrome during episodes of acute stress.
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Kazufumi Tsuchihashi,Kenji Ueshima,Tatsuro Uchida,Nobuhiro Ohmura,Kazuo Kimura,Mafumi Owa,Minoru Yoshiyama,Shunichi Miyazaki,Kazuo Haze,Hisao Ogawa,Takashi Honda,Mamoru Hase,Ryuichi Kai,Isao Morii +13 more
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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
TL;DR: Although the precise cause remains unclear, simultaneous multivessel coronary spasm at the epicardial artery or microvascular levels may contribute to the onset of tako-tsubo-like left ventricular dysfunction.