Transcript Stress cardiomyopathy in women

Stress Cardiomyopathy
Presented by Brittney Howard, PA-S
Advised by Bill Grimes, Dmin, PA-C
Me and Granny
What is Stress
Cardiomyopathy?
• Cardiac syndrome
• Reversible
• Left ventricular
apical ballooning
• Mimics myocardial
infarction
• Signs & Symptoms
 Onset following
extreme stress
 Chest pain
 Dyspnea
 ST-segment
elevation
 T wave changes
 Elevated cardiac
biomarkers
Background
• First recognized in Japan during 1990s
• Originally known as takotsubo-like left
ventricular dysfunction due to apical
response during syndrome
• Colloquially known as Broken Heart
Syndrome
Takotsubo-Like
Left Ventricular Dysfunction
takotsubo fishing pot
left ventricular
apical ballooning
www.grangeblanche.hautetfort.com
Why is Stress Cardiomyopathy
Important?
• Mimics myocardial infarction
• Differentiate from grief response
• Educate patients on favorable prognosis
• Protect patients from exposure to
unnecessary treatments
Stress Cardiomyopathy vs.
Myocardial Infarction
Stress
Cardiomyopathy
 Normal coronary
arteries, no blockage
 Results in stunning of
cardiac muscle
 Reversible condition
Myocardial Infarction
 Caused by blockages in
coronary arteries
 Results in death of
cardiac muscle
 Permanent, irreversible
damage
Possible Causes of Stress
Cardiomyopathy?
• Catecholamine
excess?
• Lack of
estrogen?
• Or both?
Diagnostic Criteria Proposed by
The Mayo Clinic
1.
2.
3.
4.
Transient loss or decreased movement of the
left ventricular apical and mid-ventricular
segments with regional wall-motion
abnormalities extending beyond a single
region supplied by a coronary vessel
Absence of obstructive coronary disease or
angiographic evidence of acute plaque rupture
New EKG abnormalities - either ST-segment
elevation or T-wave inversion
Absence of recent significant head trauma,
intracranial bleeding, pheochromocytoma,
obstructive epicardial coronary artery disease,
myocarditis, and hypertrophic
cardiomyopathy
Decreased Left Ventricular Function
• Ejection fraction in healthy individual
• >0.55
• Average ejection fraction at
presentation
• 0.39 - 0.49
• Average ejection fraction at follow-up
• 0.60-0.79
Treatment Modalities
• Alpha Blockers
• Help small blood vessels remain open
• Beta Blockers
• Reduce catecholamine effects
• Short-term Anticoagulants
• Prevent thrombus formation until function improves
• Supportive Treatment
• ACE inhibitor, aspirin, IV diuretics
• Contraindications
• Synthetic catecholamines
• Thrombolysis in ST-segment elevation
• ACE inhibitors in increased pressure gradients
The Future of Stress
Cardiomyopathy
» Importance of ESTROGEN in stress
response
» Identifiable DIAGNOSTIC measures
» RECOGNITION in medical community
» More EDUCATION about differences
of cardiac symptoms in women vs.
men
The Take Home Message
• Primarily affects
postmenopausal females
• Often precipitated by severe
stress
• Severe reversible left
ventricular dysfunction
• Mimics myocardial infarction
• Increased catecholamines and lack of
estrogen thought to play a role
• Alpha and beta blockers the best
treatment
REFERENCES
Bybee KA, Kara T, Prasad A, Lerman A, Barsnes s GW, Wright RS, et al. Systematic
review: transient l eft ventricular apical balloonin g: a syndrome that mimics STsegment elevation myocardial infarction. Ann Intern Med. 2004; 141(11):858-65.
Grawe H, Katoh M, Kuhl HP. Stress cardiom yopathy mimickin g acute coronary
syndrome: case presenta tion and review of the lit erature. Clinical Research in
Cardiolo gy. 2006; 95(3):179 -185.
John Hopkins Medicine. Frequentl y asked quest ions about broken heart syndrome.
Available at: http://www.hopkinsmedicine.or g/asc/faqs.html . Accessed Februar y 10,
2007.
Korlakunta H L, Thambidorai SK, Denne y SD, Khan IA. Transient left ventricular
apical ba lloonin g: a novel heart syndrome. Int J Cardiol. 2005; 102(2):351 -3.
Matsuoka K, Okubo S, Fujii E, Uchida F, Kasai A, Aoki T, et al. Evaluati on of the
arrhythmo genecit y of stress-induced
yopathyΣ from the time
course of t he 12-lead s urface electr ocardio gram. Am J Cardiol. 2003; 92(2):230 -3.
Reichman, Judith. Estro gen and your heart: Does it help or hurt ? November 2005.
Available at: http://www.msnbc.msn.com/id/100 34785/. Accessed Februa ry 12,
2007.
Soni A, LeLorier P. Sudden death in nondilated cardiom yopathies: patho physiolo gy
and prevention. Curr Heart Fail Rep. 2005; 2(3):118 -23.
Ueyama T1. Emotional stress -induced Takotsubo cardiom yopathy: animal model and
molecular mec hanism. Ann N Y Acad Sci. 2004; 1018:437 -44.
Ueyama T2, Senba E, Kasamatsu K, Hano T, Yamamoto K, Nishio I, et al. Molecular
mechanism of emotional
stress -induced and catecholamine -induced h eart attack. J
Cardiovasc Pharm acol. 2003; 41:S115 -8.
Questions?