Acute stress-induced cardiomyopathy: a brief observation

Acute stress-induced cardiomyopathy is a syndrome originally described in Japan but increasingly recognized all over the world. Patients typically present with chest pain triggered by an intense emotional or physiological stressor, electrocardiographic changes, and mild cardiac enzyme elevation. Patients typically return to normal cardiac function within 1 month. A retrospective review was conducted of all acute stress-induced cardiomyopathy cases at the University of Maryland Medical Center between May 2006 and May 2007. Six patients fulfilled the criteria and were included in the study. The main clinical features of the syndrome were statistically analyzed. Most patients were post-menopausal women presenting with chest pain. An emotional or physiological stressor was identified in 3 of the 6 patients. Electrocardiographic changes (ST segment elevation or T wave inversion) were present in 3 patients. All patients had left ventricular apical hypokinesis with basal hyperkinesis and elevated cardiac enzymes. The 3 patients receiving a follow up echocardiogram had improved left ventricular contractility and reduced mitral regurgitation within 1 month. Two of the patients had complete resolution in 3-4 days. Stress-induced cardiomyopathy is an important syndrome which mimics an acute myocardial infarction. It is typically self-limiting but can result in ventricular arrhythmias and cardiogenic shock. Our findings should caution clinicians that an identifiable stressor and electrocardiographic changes are not always present. In addition, our observation suggests that patients may regain normal cardiac function in less than 4 days.