Abstract | BACKGROUND: 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:
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Authors | 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 |
Journal | The New England journal of medicine
(N Engl J Med)
Vol. 352
Issue 6
Pg. 539-48
(Feb 10 2005)
ISSN: 1533-4406 [Electronic] United States |
PMID | 15703419
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright 2005 Massachusetts Medical Society. |
Chemical References |
- Catecholamines
- Neuropeptides
- Troponin I
- Serotonin
- Creatine Kinase
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Topics |
- 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)
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