Stress cardiomyopathy: clinical features and outcomes

Objectives: To establish the prevalence, clinical features, and outcomes of the recently recog- nized stress cardiomyopathy whose physiopathology is still not completely clarified. Material and methods: The prevalence and clinical findings of stress cardiomyopathy were assessed in a group of 378 patients undergoing cinecoronariography for acute coronary syndromes dur- ing a 7-year period. The inclusion criteria were severe chest pain, ischemic electrocardiogra- phic changes, reversible left ventricular dys- hypokinesia, and normal coronary arteries. Eight patients, 7 female (2.1% of all patients and 5.0% of the women), with a mean age of 65.3 ± 8.5 years fulfilled the requirements. Results: The precipitating factor was severe stress in all of them. Cardiac enzymes were slightly raised. There was apical left ventricular dyskinesia in 6 patients, midventricular in another, and diffuse hypokinesia in the remaining. One patient showed moderate mitral regurgitation. The response to con- ventional treatment and patient outcomes were favorable in all cases with prompt reversal of the left ventricular dyskinesia as assessed by echocardiography. There were 4 recurrences, 2 requiring readmission to hospital, despite continuous treatment with combined alfa and beta adrenergic blockers and calcium antagonists. Conclusions: In our hospital, stress cardiomyo- pathy had a prevalence of 2.1% in all patients with acute coronary syndromes and 5.1% in women and should be considered in their differential diagnosis, especially in middle aged female patients with a history of severe previous stress. There was a favorable outcome but recurrences may occur despite uninterrupted me- dical treatment following discharge.