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KMID : 0385920070180020107
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Journal of the Korean Society of Emergency Medicine
2007 Volume.18 No. 2 p.107 ~ p.114
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Clinical Manifestations of Novel Stress-induced Cardiomyopathy Mimicking Acute Myocardial Infarction: Single Center Emergency Department, Retrospective Study
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Jo In-Cheol
Song Hyoung-Gon
Jo Ik-Joon
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Abstract
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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.
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KEYWORD
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Stress, Cardiomyopathy, Electrocardiogram, Echocardiogram
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