J Korean Soc Emerg Med.  2007 Apr;18(2):107-114.

Clinical Manifestations of Novel Stressinduced Cardiomyopathy Mimicking Acute Myocardial Infarction: Single Center Emergency Department, Retrospective Study

• Jo IC
• Song HG
• Jo IJ

Abstract

PURPOSE: "Stress-induced cardiomyopathy"or "Takotsubo cardiomyopathy", which mimics acute myocardial infarction (AMI), has recently been reported, particularly in Japan. However, little is known about the characteristics of this syndrome. We retrospectively evaluated twenty-three cases of this novel syndrome.
METHODS
We analyzed twenty-three patients(7 men and 16 women) who fulfilled the following inclusion criteria: 1) age >18 years old; 2) no previous cardiac disease, especially coronary artery disease; 3) acute onset of symptoms; 4) ST segment elevation or depression and/or T-wave inversion on ECG; 5) cardiac enzyme elevation; 6) regional wall motion abnormality in the echocardiogram or left ventriculogram; 7) no significant stenosis in the coronary angiogram.
RESULTS
The most common stressful conditions that preceded the chest pain were: emotional stress (n=8, 34.8%), medical illness (n=7, 30.4%), accident (n=3, 13.1%), and recovery from surgery (n=3, 13.1%). The average initial creatinine kinase MB fraction and cardiac troponin I level were 32.2+/-51.7 ng/ml and 4.11+/-19.7 ng/ml, respectively. ECG changes [ST-segment elevation or depression (n=10, 43.5%) and T-wave inversion (n=19, 82.6%)] were usually found, whereas in contrast a Q wave was rarely found (n=3, 13.4%). The average left ventricular ejection fraction (LVEF) was decreased to 43.2+/-12.2% and regional wall motion abnormality [apex only (n=11, 47.8%), global (n=7, 30.4%)] was found on the initial echocardiograms. Upon follow-up echocardiograms, the average LVEF was improved to 60.6+/-5.8% and regional wall motion abnormality was normalized in all patients.
CONCLUSION
Stress-induced cardiomyopathy, mimicking AMI, is triggered by psychologically and physically stressful events. This condition is characterized by a distinctive form of systolic dysfunction and favorable outcomes with medical therapy.

Keyword

Stress; Cardiomyopathy; Electrocardiogram; Echocardiogram

MeSH Terms

Cardiomyopathies*
Chest Pain
Constriction, Pathologic
Coronary Artery Disease
Creatinine
Depression
Electrocardiography
Emergencies*
Emergency Service, Hospital*
Follow-Up Studies
Heart Diseases
Humans
Japan
Life Change Events
Male
Myocardial Infarction*
Phosphotransferases
Retrospective Studies*
Stress, Psychological
Stroke Volume
Troponin I
Creatinine
Phosphotransferases
Troponin I