Clinical Manifestation of Novel Stress-induced Cardiomyopathy Mimicking Acute Myocardial Infarction: Single Center Prospective Registry.
10.4070/kcj.2002.32.12.1054
- Author:
Ho Hyun LEE
1
;
Hyeon Cheol GWON
;
Byung Jin KIM
;
Kyung Jin LEE
;
Eul Soon IM
;
Kyung Hun WON
;
Ji Dong SUNG
;
Sang Chul LEE
;
Seung Woo PARK
;
Duk Kyung KIM
;
Sang Hoon LEE
;
Jung Don SEO
Author Information
1. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Cardiac & Vascular Center, Seoul, Korea. hcgwon@smc.samsung.co.kr
- Publication Type:Original Article
- Keywords:
Stress;
Cardiomyopathy, congestive;
Myocardial infarction;
Myocardial stunning
- MeSH:
Aneurysm;
Cardiomyopathies*;
Cardiomyopathy, Dilated;
Chest Pain;
Constriction, Pathologic;
Coronary Vasospasm;
Creatinine;
Dilatation;
Dyspnea;
Follow-Up Studies;
Heart Diseases;
Humans;
Japan;
Myocardial Infarction*;
Myocardial Stunning;
Phosphotransferases;
Prospective Studies*;
Pulmonary Edema;
Shock, Cardiogenic;
Stress, Psychological;
Stroke Volume;
Takotsubo Cardiomyopathy;
Ultrasonography, Interventional
- From:Korean Circulation Journal
2002;32(12):1054-1063
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND AND OBJECTIVES: The so-called 'stress-induced cardiomyopathy' or takotsubo cardiomyopathy, mimicking acute myocardial infarction (AMI), has recently been reported, particularly in Japan. We prospectively studied the clinical characteristics of, for the first time with a Korean series, this novel syndrome. SUBJECTS AND METHODS: Eighteen patients, fore filling the inclusion criteria, were entered onto the study. The criteria for inclusion were: 1) no previous history of cardiac disease, 2) acute onset, 3) a regional wall motion abnormality in the left ventriculogram, typically in the apical segment, and 4) no significant stenosis in the coronary angiogram. RESULTS: The events preceding the condition included: emotional stress (N=7), acute illness (N=5), non-cardiac surgery or medical procedure (N=4) and accident (N=2). Chest pain, dyspnea, or nausea/vomiting were initially noted in 12 cases (66%). Pulmonary edema was demonstrated in 10 (56%), and cardiogenic shock in 4 (23%) of the patients. The peak creatinine kinase MB fraction was 69+/-136 IU/L. A T wave inversion was noted in all patients, whereas, a Q wave was noted transiently in only 1. The average left ventricular ejection fraction (LVEF) was 38+/-8% on the initial echocardiograms. On the left ventriculograms, 15 patients showed akinetic wall motion, or aneurysmal dilatation in the apical wall, however, notably in 3 patients in the mid-ventricular wall. The coronary vasospasm provocation tests were negative in all 10 patients tested. An intravascular ultrasonography showed no infarct-related plaques in the 4 patients examined. On a follow-up echocardiogram, the average LVEF was improved to 51+/-8%, and regional wall motion was normalized after 30+/-29 days following onset. CONCLUSION: We report, for the first time in a series of Korean patients, on a novel stress-induced cardiomyopathy with transient regional wall motion abnormality, mimicking AMI. The precise etiology remains to be elucidated in further studies.
