Theoretical mechanism: reversible stunning of myocyte function associated with markedly elevated release of catecholamines
Clinical features:
(1) sudden onset of chest pain, heart failure and sometimes cardiogenic shock
(2) onset of cardiac symptoms following a sudden and severe emotional stress
(3) improvement in cardiac function (reversal) on removal of stress
Emotional stressor may be:
(1) unexpected death of a loved one
(2) accident
(3) intense argument
(4) terror of an upcoming event (court appearance, public speaking, surgical procedure)
Most patients show diffuse T-wave inversion and a prolonged QT interval on ECG.
Laboratory findings:
(1) markedly elevated plasma catecholamine levels during the period of cardiac dysfunction
(2) normal or mild elevations in cardiac enzymes (troponin, CK-MB)
Exclusions (although these patients also may have sudden emotional stress):
(1) coronary artery disease, with normal coronary arteriography and echocardiography
(2) drug abuse, especially cocaine and methamphetamine
(3) viral disease or other infection (myocarditis)
(4) other cause of cardiomyopathy
