Critical illness induced acute left ventricular myocardial dysfunction (Stress Related Cardiomyopathy

Abstract

Stress cardiomyopathy is an increasingly reported syndrome characterized by transient regional left ventricular (LV) dysfunction in the absence of significant coronary artery disease. CLINICAL MANIFESTATIONS AND DIAGNOSIS Stress cardiomyopathy is typically triggered by an acute medical illness or by intense emotional or physical stress, although a triggering event is not always present. Postulated pathogenic mechanisms include catecholamine excess, multivessel coronary artery spasm, and microvascular dysfunction. Stress cardiomyopathy may account for approximately 2 percent of suspected acute coronary syndromes. Common presenting features include electrocardiographic (ECG) abnormalities (often anterior ST elevations), elevated cardiac biomarkers, substernal chest pain, and dyspnea. Proposed diagnostic criteria include presence of transient regional wall motion abnormalities (typically not in a single coronary distribution), absence of angiographic evidence of obstructive coronary disease or acute plaque rupture, presence of new ECG abnormalities or modest troponin elevation, AND absence of myocarditis. Acute complications of stress cardiomyopathy include acute heart failure, cardiogenic shock, transient left ventricular outflow tract (LVOT) obstruction, tachyarrhythmias, and bradyarrhythmias. In-hospital mortality is approximately 2 percent. Patients who survive the acute episode typically recover normal LV function within one to four weeks.