Clinical Manifestation of Novel Stress-induced Cardiomyopathy Mimicking

Background and Objectives：The so-called ‘stress-induced cardiomyopathy ’ or takotsubo cardiomyopathy, mimicking acute myocardial infarction (AMI), has recently been reported, particularly in Japan. We pro-spectively studied the clinical characteristics of, for the first time with a Korean series, this novel syndrome. Subjects and Methods：Eighteen patients, fore filling the inclusion criteria, were entered onto the study. The criteria for inclusion were：1) no previous history of cardiac disease, 2) acute onset, 3) a regional wall motion abnormality in the left ventriculogram, typically in the apical segment, and 4) no significant stenosis in the coronary angiogram. Results：The events preceding the condition included：emotional stress (N＝7), acute illness (N＝5), non-cardiac surgery or medical procedure (N＝4) and accident (N＝2). Chest pain, dyspnea, or nausea/vomiting were initially noted in 12 cases (66%). Pulmonary edema was demonstrated in 10 (56%), and cardiogenic shock in 4 (23%) of the patients. The peak creatinine kinase MB fraction was 69±136 IU/L. A T wave inversion was noted in all patients, whereas, a Q wave was noted transiently in only 1. The average left ventricular ejection fraction (LVEF) was 38±8 % on the initial echocardiograms. On the left ventriculograms, 15 patients showed akinetic wall motion, or aneurysmal dilatation in the apical wall, however, notably in 3 patients in the mid-ventricular wall. The coronary vasospasm provocation tests were negative in all 10 patients tested. A