Acute, Reversible Left Ventricular Dysfunction in Status Asthmaticus

Levine, Glenn N.; Powell, Charles S.; Bernard, Sheilah; Sherman, Debra L.; Faling, L. Jack; Davidoff, Ravin

doi:10.1378/chest.107.5.1469

Cited by 30 publications

(13 citation statements)

References 12 publications

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“…3 We also observed dynamic intraventricular pressure gradients, which were likely secondary to the administration of dobutamine in 5 hypotensive patients. Finally, patients in the present study are similar clinically to those with forms of nonischemic myocardial stunning reported in noncardiac diseases (eg, status asthmaticus, pheochromocytoma) 26,27 and subarachnoid hemorrhage, 28 conditions that also link a neurally mediated trigger to acute LV dysfunction. 29 Given the absence of significant, fixed atherosclerotic coronary artery disease on angiography in each of the patients in the present study and the substantial area of LV myocardial dysfunction evident on both angiography and CMR, it is highly unlikely that erosion or rupture of an otherwise nonobstructive plaque (followed by spontaneous thrombolysis) played a role in the cardiac events reported here.…”

Section: Sharkey Et Al Reversible Stress Cardiomyopathy In Womensupporting

confidence: 76%

Acute and Reversible Cardiomyopathy Provoked by Stress in Women From the United States

et al. 2005

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Background-A clinical entity characterized by acute but rapidly reversible left ventricular (LV) systolic dysfunction and triggered by psychological stress is emerging, with reports largely confined to Japan. Methods and Results-Over a 32-month period, 22 consecutive patients with this novel cardiomyopathy were prospectively identified within a community-based practice in the Minneapolis-St. Paul, Minn, area. All patients were women aged 32 to 89 years old (mean 65Ϯ13 years); 21 (96%) were Ն50 years of age. The syndrome is characterized by (1) acute substernal chest pain with ST-segment elevation and/or T-wave inversion; (2) absence of significant coronary arterial narrowing by angiography; (3) systolic dysfunction (ejection fraction 29Ϯ9%), with abnormal wall motion of the mid and distal LV, ie, "apical ballooning"; and (4) profound psychological stress (eg, death of relatives, domestic abuse, arguments, catastrophic medical diagnoses, devastating financial or gambling losses) immediately preceding and triggering the cardiac events. A significant proportion of patients (37%) had hemodynamic compromise and required vasopressor agents and intra-aortic balloon counterpulsation. Each patient survived with normalized ejection fraction (63Ϯ6%; PϽ0.001) and rapid restoration to previous functional cardiovascular status within 6Ϯ3 days. In 95%, MRI identified diffusely distributed segmental wall-motion abnormalities that encompassed LV myocardium in multiple coronary arterial vascular territories. Conclusions-A reversible cardiomyopathy triggered by psychologically stressful events occurs in older women and may mimic evolving acute myocardial infarction or coronary syndrome. This condition is characterized by a distinctive form of systolic dysfunction that predominantly affects the distal LV chamber and a favorable outcome with appropriate medical therapy.

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Section: Sharkey Et Al Reversible Stress Cardiomyopathy In Womensupporting

confidence: 76%

Acute and Reversible Cardiomyopathy Provoked by Stress in Women From the United States

et al. 2005

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“…Similar focal wall motion abnormalities have been reported in conjunction with other medical conditions with presumed or proven elevation in catecholamine levels, such as subarachnoid hemorrhage (SAH), pheochromocytoma, multivessel spasm and pulmonary diseases [7, 8, 9]. In some instances, such as treatment of pheochromocytoma, LV dysfunction resolves.…”

Section: Discussionmentioning

confidence: 56%

“…Acute, severe pulmonary disease was a common precipitating factor in transient apical ballooning [9, 13]and was present in half of our cases. Acute respiratory distress would likely be associated with high levels of circulating catecholamines; it has been shown that in acute, severe attacks of asthma, norepinephrine levels are up to 2–3 times higher than in stable asthmatics [14].…”

Section: Discussionmentioning

confidence: 99%

A Syndrome of Transient Left Ventricular Apical Wall Motion Abnormality in the Absence of Coronary Disease: A Perspective from the United States

et al. 2003

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Background: The syndrome of chest pain associated with characteristic anterior electrocardiographic changes, moderate increases in cardiac enzymes, and a reversible apical wall motion abnormality in the absence of coronary artery disease has been documented in Japan, but has received relatively little attention in other countries. Methods: The clinical and echocardiographic data of 12 patients (11 women, mean age 64 ±14 years) who presented with chest symptoms, electrocardiographic (ECG) changes indicative of an acute anteroapical myocardial infarction, abnormal cardiac enzyme levels and echocardiography showing an apical wall motion abnormality were collected. Coronary angiography was performed in 10 patients. A follow-up echocardiogram was obtained within 2 weeks of the initial diagnosis in most cases. Results: An identifiable, precipitating (‘trigger’) event could be identified in all 12 individuals. Respiratory distress was present in 7, the death of a relative in 3, in 4 a surgical or medical procedure had been performed, and in 1 a panic disorder was diagnosed. The echocardiograms showed a characteristic wall motion pattern of significant apical dysfunction. All of the patients who underwent coronary arteriography had noncritical coronary artery disease. Follow-up echocardiography showed normalization of the LV dysfunction in all instances. Conclusion: We identified a syndrome of chest pain, dyspnea, ECG and enzyme changes mimicking acute myocardial infarction, similar to the ‘Takotsubo’ syndrome described in Japan. It is likely that the widespread use of echocardiography, coupled with increased recognition of this syndrome, will result in this diagnosis being made more commonly.

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“…The ability to induce diffuse, extreme, multivessel spasm with apical ballooning by acetylcholine testing is an unreported occurrence in Prinzmetal angina [26][27][28][29], and its recognition would be especially relevant both for demonstrating the pathophysiology of LVAB (if confirmed in larger studies) and for determining which patients have the potential for LVAB and which pharmacologic treatments may improve or worsen the syndrome. In particular, some of the medications frequently used with impunity in the context of ACS of an atherosclerotic origin include vasopressors, beta agonists, thrombolytics, or anticoagulants; however, their use may be contraindicated in cases of ACS due to LVAB [30][31][32][33].…”

Section: Discussionmentioning

confidence: 99%

Transient left ventricular apical ballooning: A unifying pathophysiologic theory at the edge of Prinzmetal angina

Angelini

2008

Cathet Cardio Intervent

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Acute, Reversible Left Ventricular Dysfunction in Status Asthmaticus

Cited by 30 publications

References 12 publications

Acute and Reversible Cardiomyopathy Provoked by Stress in Women From the United States

Acute and Reversible Cardiomyopathy Provoked by Stress in Women From the United States

A Syndrome of Transient Left Ventricular Apical Wall Motion Abnormality in the Absence of Coronary Disease: A Perspective from the United States

Transient left ventricular apical ballooning: A unifying pathophysiologic theory at the edge of Prinzmetal angina

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