Transient Left Ventricular Dysfunction Under Severe Stress: Brain-Heart Relationship Revisited

• Published in: The American journal of medicine Vol. 119; no. 1; pp. 10 - 17
• Main Authors: Ako, Junya, Sudhir, Krishnankutty, Farouque, H.M. Omar, Honda, Yasuhiro, Fitzgerald, Peter J.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2006; Elsevier; Elsevier Sequoia S.A
• Subjects: Biological and medical sciences; Brain; Cardiology. Vascular system; Electrocardiography; Female; Female gender; Females; General aspects; Heart; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Medical disorders; Medical research; Medical sciences; Microvascular; Stress; Stress, Physiological - complications; Stress, Psychological - complications; Stunned myocardium; Subarachnoid hemorrhage; Sympathetic nervous system; Sympathetic Nervous System - physiopathology; Syndrome; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - physiopathology; Ventricular Dysfunction, Left - therapy; Microvascular; Sympathetic nervous system; Female gender; Subarachnoid hemorrhage; Stunned myocardium; Heart; Medicine; Brain; Heart disease; Cardiovascular disease; Heart ventricle; Left ventricular failure; Left ventricle performance; Severe; Stress; Transitory; Encephalon
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2005.08.022

Transient left ventricular dysfunction in patients under emotional or physical stress, also known as tako-tsubo-like left ventricular dysfunction, has been recently been recognized as a distinct clinical entity. The aims of this review are to define this phenomenon and to explore its similarities to the left ventricular dysfunction seen in patients with acute brain injury. MEDLINE database, bibliographies of each citation for relevant articles, and consultation with clinical experts were used to examine the clinical picture of tako-tsubo-like left ventricular dysfunction. We identified case series and a systematic review that report on patients with this syndrome. This phenomenon occurs predominantly in female patients, presenting with a variety of ST-T segment changes and mildly elevated cardiac enzymes that mimic an acute coronary syndrome. The left ventricular dysfunction, typically showing a hyperkinetic basal region and an akinetic apical half of the ventricle, occurs in the absence of obstructed epicardial coronary arteries. The ventricular dysfunction usually resolves within weeks with a generally favorable prognosis. This phenomenon has similarities to that seen in patients with acute brain injury with regard to clinical presentation, pathology, and its reversible nature. Transient left ventricular dysfunction occurs in the absence of obstructive epicardial coronary artery disease. In its broadest sense, this phenomenon may encompass a range of disorders including left ventricular dysfunction after central nervous system injury.