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Stress cardiomyopathy (SCMP) is characterized by reversible apical ventricular dysfunction in the absence of obstructive CAD. Most often it is preceded by physical or emotional stress. Most studies have been relatively small and the mechanism remains poorly understood. We have established a large database of patients with SCMP to further characterize this disease.
We reviewed the records of 80 patients with SCMP at Danbury Hospital from 2005–2012 with emphasis on clinical characteristics, presentation, triggers, EKG findings, echocardiography, and cardiac catheterization.
Of the 80 patients, 91% were female with a mean age of 66.7 years (31–87). 62.5% had HTN, 22.2% were diabetic, and 48.6% had dyslipidemia. Tobacco use was present in 52.5%. Alcohol use was seen in 37.5%. Mean BMI was 25.97. On presentation, 71.3% had chest pain, 18.8% had dyspnea, 16.3% had gastrointestinal symptoms, 11.3% had diaphoresis, 7.5% had neurologic symptoms, 5% had syncope, and 5% had seizures. No stressor was identified in 46.3%. 36.3% of patients had a physical stress and 17.5% had a strong positive or negative emotion as a trigger. Males with SCMP had either no trigger (58%) or a physical stress (42%). 31% occured during the summer. EKG changes included ST elevations (31.3%), T wave inversions (52.1%), and ST depressions (16.7%). Mean QTC was prolonged at 496.7 msec. Incidence of new-onset atrial fibrillation was 8.8% and of sustained ventricular arrhythmias was 2.5%. Mean EF on presentation was 38%. 46.9% of patients had non-obstructive CAD. 6.3% of patients were treated in the ICU for cardiogenic shock. The average length of stay was 5.28 days. Recurrence was seen in 5%; patients reported different stressors but had a similar pattern of apical ballooning.
SCMP is thought of as a reversible cardiomyopathy with good prognosis that affects postmenopausal women. Although the majority had an uncomplicated clinical course, atrial and ventricular arrhythmias and cardiogenic shock were not infrequent. Men were more likely to report no trigger or a physical stress and had a shorter QTc. Ongoing assessment will be important to elucidate mechanism and help identify vulnerable patients.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Stress, Coronary Spasm and AMI: Lessons from Japan, New Orleans, Greece
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1130-209
- 2013 American College of Cardiology Foundation