BACKGROUND: Reversible left ventricular dysfunction precipitated by emotional stress has been reported, but the mechanism remains unknown. METHODS: We evaluated 19 patients who presented with left ventricular dysfunct...BACKGROUND: Reversible left ventricular dysfunction precipitated by emotional stress has been reported, but the mechanism remains unknown. METHODS: We evaluated 19 patients who presented with left ventricular dysfunction after sudden emotional stress. All patients underwent coronary angiography and serial echocardiography; five underwent endomyocardial biopsy. Plasma catecholamine levels in 13 patients with stress-related myocardial dysfunction were compared with those in 7 patients with Killip class III myocardial infarction. RESULTS: The median age of patients with stress-induced cardiomyopathy was 63 years, and 95 percent were women. Clinical presentations included chest pain, pulmonary edema, and cardiogenic shock. Diffuse T-wave inversion and a prolonged QT interval occurred in most patients. Seventeen patients had mildly elevated serum troponin I levels, but only 1 of 19 had angiographic evidence of clinically significant coronary disease. Severe left ventricular dysfunction was present on admission(median ejection fraction, 0.20; interquartile range, 0.15 to 0.30) and rapidly resolved in all patients(ejection fraction at two to four weeks, 0.60; interquartile range, 0.55 to 0.65; P< 0.001). Endomyocardial biopsy showed mononuclear infiltrates and contraction-band necrosis. Plasma catecholamine levels at presentation were markedly higher among patients with stress-induced cardiomyopathy than among those with Killip class III myocardial infarction(median epinephrine level, 1264 pg per milliliter[interquartile range, 916 to 1374] vs. 376 pg per milliliter[interquartile range, 275 to 476]; norepinephrine level, 2284 pg per milliliter[interquartile range, 1709 to 2910] vs. 1100 pg per milliliter[interquartile range, 914 to 1320]; and dopamine level, 111 pg per milliliter[interquartile range, 106 to 146] vs. 61 pg per milliliter[interquartile range, 46 to 77]; P< 0.005 for all comparisons). CONCLUSIONS: Emotional stress can precipitate severe, reversible left ventricular dysfunction in patients without coronary disease. Exaggerated sympathetic stimulation is probably central to the cause of this syndrome.展开更多
Objective The purpose of this study w as to examine racialethnic disparities in stress ful life events before and during pregnancy and to assess the re lationship between stressful life events and racial -ethnic dispa...Objective The purpose of this study w as to examine racialethnic disparities in stress ful life events before and during pregnancy and to assess the re lationship between stressful life events and racial -ethnic disparities in preterm birth.Study design Using data from the Pregnancy Risk Assessment Monitoring System,we conducted a ret-rospective cohort analysis of a samp le of 33,542women from 19states who were delivered of a live -born infant in2000.Principal component analysis was used to group 13stressful life events into 4stress c onstructs:emotional,fi-nancial,partner -related,and trau matic.Racialethnic disparities in stressful life event s were assessed with the use of bivariate and multivariate regre ssion analyses.The con-tribution of stressful life events t o racial -ethnic disparities in preterm birth was evaluated with t he use of stepwise re-gression model and interaction term s.Results Black women and American Indian /Alaska Native w omen reported the highest number of stressful life eve nts in the 12months before delivery.Compared with non -Hispanic white wom-en,black women were 24%more likely t o report emotionalstressors,35%more likely to report financial stressors,163%more likely to report partner -r elated stressors,and83%more likely to report traumatic s tressors.The addition of stress constructs to the stepwise regression model mini-mally affected the association betw een race -ethnicity and preterm birth,and none of the stress constructs were sig-nificantly associated with preterm birth.There were no significant interaction effects between race -ethnicity and stress on preterm birth,except for a modest effect between black race and traumatic stressors.Conclusion There are significant racial -ethnic disparities in the experience of stressful life events before and dur ing pregnancy.Stressful life events do not appear to contribute significantly to racial -ethnic disparities in prete rm birth.展开更多
文摘BACKGROUND: Reversible left ventricular dysfunction precipitated by emotional stress has been reported, but the mechanism remains unknown. METHODS: We evaluated 19 patients who presented with left ventricular dysfunction after sudden emotional stress. All patients underwent coronary angiography and serial echocardiography; five underwent endomyocardial biopsy. Plasma catecholamine levels in 13 patients with stress-related myocardial dysfunction were compared with those in 7 patients with Killip class III myocardial infarction. RESULTS: The median age of patients with stress-induced cardiomyopathy was 63 years, and 95 percent were women. Clinical presentations included chest pain, pulmonary edema, and cardiogenic shock. Diffuse T-wave inversion and a prolonged QT interval occurred in most patients. Seventeen patients had mildly elevated serum troponin I levels, but only 1 of 19 had angiographic evidence of clinically significant coronary disease. Severe left ventricular dysfunction was present on admission(median ejection fraction, 0.20; interquartile range, 0.15 to 0.30) and rapidly resolved in all patients(ejection fraction at two to four weeks, 0.60; interquartile range, 0.55 to 0.65; P< 0.001). Endomyocardial biopsy showed mononuclear infiltrates and contraction-band necrosis. Plasma catecholamine levels at presentation were markedly higher among patients with stress-induced cardiomyopathy than among those with Killip class III myocardial infarction(median epinephrine level, 1264 pg per milliliter[interquartile range, 916 to 1374] vs. 376 pg per milliliter[interquartile range, 275 to 476]; norepinephrine level, 2284 pg per milliliter[interquartile range, 1709 to 2910] vs. 1100 pg per milliliter[interquartile range, 914 to 1320]; and dopamine level, 111 pg per milliliter[interquartile range, 106 to 146] vs. 61 pg per milliliter[interquartile range, 46 to 77]; P< 0.005 for all comparisons). CONCLUSIONS: Emotional stress can precipitate severe, reversible left ventricular dysfunction in patients without coronary disease. Exaggerated sympathetic stimulation is probably central to the cause of this syndrome.
文摘Objective The purpose of this study w as to examine racialethnic disparities in stress ful life events before and during pregnancy and to assess the re lationship between stressful life events and racial -ethnic disparities in preterm birth.Study design Using data from the Pregnancy Risk Assessment Monitoring System,we conducted a ret-rospective cohort analysis of a samp le of 33,542women from 19states who were delivered of a live -born infant in2000.Principal component analysis was used to group 13stressful life events into 4stress c onstructs:emotional,fi-nancial,partner -related,and trau matic.Racialethnic disparities in stressful life event s were assessed with the use of bivariate and multivariate regre ssion analyses.The con-tribution of stressful life events t o racial -ethnic disparities in preterm birth was evaluated with t he use of stepwise re-gression model and interaction term s.Results Black women and American Indian /Alaska Native w omen reported the highest number of stressful life eve nts in the 12months before delivery.Compared with non -Hispanic white wom-en,black women were 24%more likely t o report emotionalstressors,35%more likely to report financial stressors,163%more likely to report partner -r elated stressors,and83%more likely to report traumatic s tressors.The addition of stress constructs to the stepwise regression model mini-mally affected the association betw een race -ethnicity and preterm birth,and none of the stress constructs were sig-nificantly associated with preterm birth.There were no significant interaction effects between race -ethnicity and stress on preterm birth,except for a modest effect between black race and traumatic stressors.Conclusion There are significant racial -ethnic disparities in the experience of stressful life events before and dur ing pregnancy.Stressful life events do not appear to contribute significantly to racial -ethnic disparities in prete rm birth.
