Sympathetic nerve activity in stress-induced cardiomyopathy
To evaluate directly recorded efferent sympathetic nerve traffic in patients with stress-induced cardiomyopathy (SIC).
SIC is a syndrome affecting mostly postmenopausal women following severe emotional stress. Though the precise pathophysiology is not well understood, a catecholamine overstimulation of the myocardium is thought to underlie the pathogenesis.
Direct recordings of multiunit efferent postganglionic muscle sympathetic nerve activity (MSNA) were obtained from 12 female patients, 5 in the acute (24–48 h) and 7 in the recovery phase (1–6 months), with apical ballooning pattern and 12 healthy matched controls. MSNA was expressed as burst frequency (BF), burst incidence (BI) and relative median burst amplitude (RMBA %). One of the twelve patients in this study was on beta blockade treatment due to a different illness, at time of onset of SIC. All patients were investigated with ongoing medication.
MSNA was lower in patients with SIC as compared to matched controls, but did not differ between the acute and recovery phase of SIC. RMBA %, blood pressure and heart rate did not differ between the groups.
MSNA is shown to be lower in patients with SIC compared to healthy controls, suggesting that sympathetic neuronal outflow is rapidly reduced following the initial phase of SIC. A distension of the ventricular myocardium, due to excessive catecholamine release over the heart in the acute phase, may increase the firing rate of unmyelinated cardiac c-fibre afferents resulting in widespread sympathetic inhibition. Such a mechanism may underlie the lower MSNA reported in our patients.
- Esler, M, Schwarz, R, Alvarenga, M (2008) Mental stress is a cause of cardiovascular diseases: from scepticism to certainty. Stress Health 24: pp. 175-180 CrossRef
- Dote, K, Sato, H, Tateishi, H, Uchida, T, Ishihara, M (1991) Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases. J Cardiol 21: pp. 203-214
- Wittstein, IS (2008) Acute stress cardiomyopathy. Curr Heart Fail Rep 5: pp. 61-68 CrossRef
- Tsuchihashi, K, Ueshima, K, Uchida, T, Oh-mura, N, Kimura, K, Owa, M (2001) Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina pectoris-myocardial infarction investigations in Japan. J Am Coll Cardiol 38: pp. 11-18 CrossRef
- Orth-Gomer, K, Wamala, SP, Horsten, M, Schenck-Gustafsson, K, Schneiderman, N, Mittleman, MA (2000) Marital stress worsens prognosis in women with coronary heart disease: the Stockholm female coronary risk study. JAMA 284: pp. 3008-3014 CrossRef
- Kneale, BJ, Chowienczyk, PJ, Brett, SE, Coltart, DJ, Ritter, JM (2000) Gender differences in sensitivity to adrenergic agonists of forearm resistance vasculature. J Am Coll Cardiol 4: pp. 1233-1238 CrossRef
- Zhou, JQ, Haddad, F, Tremmel, JA, Spin, JM (2010) A big man with a broken heart: stress-induced cardiomyopathy in a morbidly obese man. Mayo Clin Proc 85: pp. 864-865 CrossRef
- Wittstein, IS, Thiemann, DR, Lima, JA, Baughman, KL, Schulman, SP, Gerstenblith, G (2005) Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 352: pp. 539-548 CrossRef
- Nef, HM, Mollmann, H, Kostin, S, Troidl, C, Voss, S, Weber, M (2007) Tako-Tsubo cardiomyopathy: intraindividual structural analysis in the acute phase and after functional recovery. Eur Heart J 28: pp. 2456-2464 CrossRef
- Lagerqvist, B, James, SK, Stenestrand, U, Lindback, J, Nilsson, T, Wallentin, L (2007) Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden. N Engl J Med 356: pp. 1009-1019 CrossRef
- Stenestrand, U, Lindback, J, Wallentin, L (2006) Long-term outcome of primary percutaneous coronary intervention vs. prehospital and in-hospital thrombolysis for patients with ST-elevation myocardial infarction. JAMA 296: pp. 1749-1756 CrossRef
- Low, PA Clinical autonomic disorders. In: Wallin, BG, Elam, M eds. (1997) Microneurography and autonomic dysfunction. Lippincott-Raven, Philadelphia
- Vallbo, AB, Hagbarth, KE, Torebjork, HE, Wallin, BG (1979) Somatosensory, proprioceptive, and sympathetic activity in human peripheral nerves. Physiol Rev 59: pp. 919-957
- Sverrisdóttir, YB, Rundqvist, B, Elam, M (1998) Relative burst amplitude in human muscle sympathetic nerve activity: a sensitive indicator of altered sympathetic traffic. Clin Auton Res 8: pp. 95-100 CrossRef
- Hogarth, AJ, Graham, LN, Mary, DASG, Greenwood, JP (2009) Gender differences in sympathetic neural activation following uncomplicated acute myocardial infarction. Eur Heart J 30: pp. 1764-1770 CrossRef
- Campagna, JA, Carter, C (2003) Clinical relevance of the Bezold-Jarisch reflex. Anesthesiology 98: pp. 1250-1260 CrossRef
- Folkow, B Relevance of cardiovascular reflexes. In: Hainsworth, R, Kidd, C, Linden, RJ eds. (1979) Cardiac receptors. Cambridge University Press, Cambridge, pp. 473-505
- Wallin, BG, Sundlof, G, Eriksson, BM, Dominiak, P, Grobecker, H, Lindblad, LE (1981) Plasma noradrenaline correlates to sympathetic muscle nerve activity in normotensive man. Acta Physiol Scand 111: pp. 69-73 CrossRef
- Wallin, BG, Thompson, JM, Jennings, GL, Esler, MD (1996) Renal noradrenaline spillover correlates with muscle sympathetic activity in humans. J Physiol 491: pp. 881-887
- Rundqvist, B, Elam, M, Bergman-Sverrisdottir, Y, Eisenhofer, G, Friberg, P (1997) Increased cardiac adrenergic drive precedes generalized sympathetic activation in human heart failure. Circulation 95: pp. 169-175 CrossRef
- Bini, G, Hagbarth, KE, Hynninen, P (1980) Thermoregulatory and rhythm-generating mechanisms governing the sudomotor and vasoconstrictor outflow in human cutaneous nerves. J Physiol 306: pp. 537-552
- Grassi, G, Seravalle, G, Turri, C, Bertinieri, G, Dell’Oro, R, Mancia, G (2003) Impairment of thermoregulatory control of skin sympathetic nerve traffic in the elderly. Circulation 108: pp. 729-735 CrossRef
- Sympathetic nerve activity in stress-induced cardiomyopathy
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Clinical Autonomic Research
Volume 22, Issue 6 , pp 259-264
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- 1. Department of Clinical Neurophysiology, Institute of Neuroscience and Physiology, Gothenburg, Sweden
- 3. Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK
- 4. Nuffield Department of Surgical Sciences, John Radcliffe Hospital Headington, Oxford, OX3 9DU, UK
- 2. Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden