Sudden emotional distress, such as that caused by an unexpected death, can sometimes produce severe transient left ventricular dysfunction. This stress-induced cardiomyopathy appears to be a form of ...myocardial stunning associated with marked sympathetic stimulation.
Sudden emotional distress, such as that caused by an unexpected death, can sometimes produce severe transient left ventricular dysfunction.
The potentially lethal consequences of emotional stress are deeply rooted in folk wisdom, as reflected by phrases such as “scared to death” and “a broken heart.” In the past decade, cardiac contractile abnormalities and heart failure have been reported after acute emotional stress,
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but the mechanism remains unknown. We evaluated 19 patients with “stress cardiomyopathy,” a syndrome of profound myocardial stunning precipitated by acute emotional stress, in an effort to identify the clinical features that distinguish this syndrome from acute myocardial infarction and the cause of transient stress-induced myocardial dysfunction.
Methods
Study Patients
Nineteen previously healthy patients were admitted . . .
To define the current role of EMB in the management of cardiovascular disease, a multidisciplinary group of experts in cardiomyopathies and cardiovascular pathology was convened by the American Heart ...Association (AHA), the American College of Cardiology (ACC), and the European Society of Cardiology (ESC). Reviewer Employment Research Grant Other Research Support Speakers' Bureau/Honoraria Expert Witness Ownership Interest Consultant/ Advisory Board Other Mazen Abu-Fadel Ponca City Medical Center None None None None None None None Jeffrey Anderson LDS Hospital None None None None None None None Eloisa Arbustini I.R.C.C.S. Policlinico San Matteo, Pavia, Italy None None None None None None None Eric Bates University of Michigan None None None None None None None Fred Bove Temple University Penn Dept of Health None None None None Insight Telehealth Systems* None Rihal Charanjit Mayo Clinic None None None None None None None G. William Dec Massachusetts General Hospital None None None None None None None Jose Diez Baylor College of Medicine None None None None None Sanofi-Aventis* None Mark Eisenberg McGill University None None None None None None None Gerasimos Filippatos Evangelismos Hospital, Athens, Greece None None None None None None None Robert Harrington Duke University None None None None None None None Mark Hlatky Stanford University None None None None None None None Maryl Johnson University of Wisconsin None None None None None None None Jay Mason Covance Central Diagnostics None None None None None None None Walter Paulus VU University Medical Center, Netherlands None None None None None None None Richard Schofield University of Florida None None AstraZeneca*; AtCor Medical*; Novartis*; Pfizer*; Scios* None None Pfizer* None Udo Sechtem Robert-Bosch-Medical Center, Stuttgart, Germany None None None None None None None Ajay Shah King's College London None None None None None None None Samuel J. Shubrooks, Jr Beth Israel Deaconess Medical Center None None None None None None None * Reviewer Disclosures This table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all reviewers are required to complete and submit.
CONTEXT Implantable cardioverter defibrillator (ICD) therapy is effective in
primary and secondary prevention of sudden cardiac death among patients with
prior myocardial infarction and depressed ...ejection fraction. However, conclusive
evidence of survival benefit in patients with nonischemic cardiomyopathy (NICM)
is still lacking. OBJECTIVE To determine whether ICD therapy reduces all-cause mortality in patients
with NICM. DATA SOURCES MEDLINE (1966-2004), EMBASE (1991-2004), the Cochrane Central Register
of Controlled Trials (through first quarter, 2004), reports presented at scientific
meetings (2003-2004), and bibliographic review of secondary sources. Search
terms included defibrillator, randomized controlled trials,
clinical trials, andsudden death. STUDY SELECTION Eligible studies were prospective randomized controlled trials of ICD
or combined cardiac resynchronization therapy and defibrillator (CRT-D) vs
medical therapy enrolling at least some individuals with NICM and reporting
all-cause mortality as an outcome. Of 675 potentially relevant articles screened
initially, 8 reports of randomized trials enrolling a total of 2146 patients
with NICM were included. DATA EXTRACTION Included studies were reviewed to determine the number of patients randomized,
mean duration of follow-up, primary end point, mortality of ICD cohort, and
mortality of control cohort. DATA SYNTHESIS Five primary prevention trials enrolling 1854 patients with NICM were
identified; pooled analysis suggested a significant reduction in total mortality
among patients randomized to ICD or CRT-D vs medical therapy (risk ratio RR, 0.69;
95% confidence interval CI, 0.55-0.87; P = .002).
Mortality reduction remained significant even after elimination of CRT-D trials.
Two of the 3 secondary prevention trials presented subgroup estimates for
ICD efficacy in NICM. Pooled analysis of these secondary prevention trials
(n = 256 patients with NICM) indicated an equivalent but nonsignificant
mortality reduction with ICD therapy (RR, 0.69; 95% CI, 0.39-1.24; P = .22). Analysis of all 7 trials combined demonstrated
a statistically significant 31% overall reduction in mortality with ICD therapy
(RR, 0.69; 95% CI, 0.56-0.86; P = .002). CONCLUSION ICD therapy appears to significantly reduce mortality in selected patients
with NICM.
Despite advances in drug therapy, the prognosis of patients with heart failure remains poor.
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The accurate assessment of prognosis in patients with this disorder is critical, to ensure that patients ...with the most severe disease receive appropriate consideration for the limited number of hearts available for transplantation. Although substantial research has demonstrated the prognostic value of a variety of clinical characteristics in patients with heart failure,
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few data are available on the association between the cause of cardiomyopathy and the long-term prognosis.
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Previous studies addressing the influence of the underlying cause on prognosis have generally compared patients with . . .
Lymphocytic myocarditis remains a poorly characterized disorder. Approximately 10 percent of patients with cardiomyopathy of recent onset who undergo endomyocardial biopsy have this condition, which ...is presumed to be caused by viral infection.
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The clinical course of patients with lymphocytic myocarditis varies; some patients have subclinical disease,
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some present with fulminant disease, which is frequently fatal,
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and others have indolent disease that progresses to dilated cardiomyopathy.
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Although a histopathological classification system, referred to as the Dallas criteria, has been widely applied in the diagnosis of myocarditis since 1987,
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whether these criteria alone can be used to predict . . .
Left ventricular dysfunction, regardless of its cause, results in characteristic hemodynamic derangements and a process of neurohormonal activation. Among the neuronal and hormonal pathways activated ...are the sympathetic nervous system, the renin–angiotensin–aldosterone system, and the endothelin pathway. Each of these pathways has hemodynamic effects that maintain tissue perfusion and blood pressure, and the sympathetic nervous system also stimulates the heart rate and myocardial contractility. Although these responses initially compensate for hemodynamic derangements, prolonged elevation of norepinephrine, renin, angiotensin I and II, aldosterone, and endothelin becomes directly toxic to the heart, accelerating processes such as apoptosis, myocyte hypertrophy, and interstitial fibrosis. . . .
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