Severe, sudden emotional stress can result in myocardial stunning and dysfunction. Wittstein et al identified clinical features of the syndrome. The authors are from Johns Hopkins University in Baltimore and Brigham and Women's Hospital in Boston.


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


To read more or access our algorithms and calculators, please log in or register.