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J Am Coll Cardiol. 2018 Oct 16;72(16):1955-1971. doi: 10.1016/j.jacc.2018.07.072.

Stress Cardiomyopathy Diagnosis and Treatment: JACC State-of-the-Art Review.

Author information

1
VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Department of Cardiology, Hospital Italiano, Buenos Aires, Argentina.
2
VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; 'Dianne and C. Kenneth Wright' Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia.
3
'Dianne and C. Kenneth Wright' Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia.
4
Institute of Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia.
5
'Dianne and C. Kenneth Wright' Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia; Institute of Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia.
6
Department of Cardiology, Hospital Italiano, Buenos Aires, Argentina.
7
VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; 'Dianne and C. Kenneth Wright' Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia. Electronic address: antonio.abbate@vcuhealth.org.

Abstract

Stress cardiomyopathy is an acute reversible heart failure syndrome initially believed to represent a benign condition due to its self-limiting clinical course, but now recognized to be associated with a non-negligible rate of serious complications such as ventricular arrhythmias, systemic thromboembolism, and cardiogenic shock. Due to an increased awareness and recognition, the incidence of stress cardiomyopathy has been rising (15-30 cases per 100,000 per year), although the true incidence is unknown as the condition is likely underdiagnosed. Stress cardiomyopathy represents a form of neurocardiogenic myocardial stunning, and while the link between the brain and the heart is established, the exact pathophysiological mechanisms remain unclear. We herein review the proposed risk factors and triggers for the syndrome and discuss a practical approach to diagnosis and treatment of the patients with stress cardiomyopathy, highlighting potential challenges and unresolved questions.

KEYWORDS:

Takotsubo; cardiomyopathy; stress

PMID:
30309474
DOI:
10.1016/j.jacc.2018.07.072

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