・JAMAをみていたら、以下のような論文がありました。
Acute Emotional Stress and Cardiac Arrhythmias
Roy C. Ziegelstein,MD
JAMA. 2007;298:324-329.
（この記事の表題を「精神的ストレス」としましたが、emotionalは情動と訳すべきかも知れませんが、世の中のとおりのよさでは精神的と訳してました。）
・この論文では、急性の精神的ストレスの心臓への悪影響を以下のような三つに分類していました。
Adverse Effects of Acute Emotional Stress on the Heart
①Left Ventricular Dysfunction (Stress Cardiomyopathy or Takotsubo Cardiomyopathy)
Typically occurs in an older woman.
Sudden chest pain and shortness of breath occurs soon after an emotionally stressful or traumatic experience.
Left ventricular dysfunction most prominently affects the cardiac apex.
Effects of high levels of catecholamines have been implicated.
②Myocardial Ischemia
Systemic vascular resistance increases during mental or emotional stress although myocardial oxygen demand also increases.
Individuals with coronary artery disease may develop myocardial ischemia during emotional or mental stress even if their exercise or chemical nuclear stress test results are negative.
③Ventricular Arrhythmias
At least 20% of episodes of serious ventricular arrhythmias or sudden cardiac death are precipitated by intense or unusual emotional tress.
Intense emotions may lead to particularly lethal ventricular arrhythmias.
Asymmetric brain activity may produce areas of inhomogeneous ventricular repolarization that create electrical instability in the heart.
・で、赤字の蛸壺心筋症については、UpToDateには、以下のような記載があります。
Takotsubo cardiomyopathy was first described in Japan. The name of the disorder is taken from the Japanese name for an octopus trap (tako-tsubo), which has a shape that is similar to the ballooning configuration of the LV in this disorder. In the most commonly described manifestations of stress-induced cardiomyopathy, the function of the distal and apical segments of the LV are depressed, and there is compensatory hyperkinesis of the basal walls, producing ballooning of the apex with systole. Subsequently, stress-induced cardiomyopathy has been described in non-Asian populations, including the United States and Europe .
日本人が最初に報告したということですね。
心筋梗塞との鑑別で覚えておくべき疾患ですね。
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