Not a broken heart

ECG abnormalities that can sometimes distinguish the syndrome from anterior myocardial infarction include more prominent ST-segment elevation in leads V4-6 than in leads Vl-3, absent reciprocal changes in the inferior leads, deep precordial or global T-wave inversions, and striking prolongation of t...

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Bibliographic Details
Published in:The Lancet (British edition) 2007-08, Vol.370 (9587), p.628-628
Main Authors: Van Spall, Harriette GC, MD, Roberts, Jason D, MD, Sawka, Anna M, MD, Swallow, Carol J, MD, Mak, Susanna, Dr
Format: Article
Language:English
Subjects:
Abdominal Neoplasms - complications
Abdominal Neoplasms - pathology
Acute coronary syndromes
Adult
Cardiomyopathies - diagnosis
Cardiomyopathies - etiology
Catecholamines - metabolism
Diagnosis, Differential
Female
Heart attacks
Heart failure
Humans
Internal Medicine
Medical imaging
Myocardial infarction
Paraganglioma, Extra-Adrenal - complications
Paraganglioma, Extra-Adrenal - pathology
Physical examinations
Psychology
Stress, Psychological - complications
Ventricular Dysfunction, Left - etiology
Ventricular Dysfunction, Left - pathology
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Summary:ECG abnormalities that can sometimes distinguish the syndrome from anterior myocardial infarction include more prominent ST-segment elevation in leads V4-6 than in leads Vl-3, absent reciprocal changes in the inferior leads, deep precordial or global T-wave inversions, and striking prolongation of the QT interval.1 When caused by psychological stress, transient LVAB syndrome is known as Takotsubo cardiomyopathy, a name derived from the round-bottomed, narrow-necked Japanese octopus trap ("tako-tsubo") that the left ventricle resembles in systole. Raised plasma catecholamine concentrations have recently been reported in a cohort of patients with transient LVAB syndrome.2 The specific mechanisms by which catecholamine excess causes transient LVAB are unknown, but could, include epicardial or microvascular spasm, or direct myocardial injury.2 The cardiac apex may be particularly sensitive to adrenergic stimulation.3 In our patient, catecholamine secretion from a paraganglioma caused cardiac changes indistinguishable from Takotsubo cardiomyopathy, supporting the hypothesis that the effects of psychological stress on the heart are mediated by catecholamines.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(07)61302-6