[The "broken heart" syndrome--a rare clinical phenomenon].

BACKGROUND AND OBJECTIVE: A clinical entity that mimics acute coronary syndrome with reversible left ventricular systolic dysfunction and is triggered by emotional stress was identified in 6 patients by screening a database of > 1000 patients with the ICD-10 coding of acute coronary syndrome. The search criteria were acute coronary syndrome, normal coronary anatomy, absence of coronary lesions and transient left ventricular dysfunction, triggered by emotional stress.

PATIENTS AND METHODS: We analyzed 6 patients, who fulfilled the criteria of (1) acute substernal chest pain with ST-segment elevation and/or T-wave inversion; (2) absence of significant coronary arterial narrowing on angiography, (3) systolic dysfunction with abnormal regional wall motion ("apical ballooning") in the context of (4) severe psychological stress immediately before and triggering the cardiac events.

RESULTS: The primary diagnosis for all 6 acutely ill patients accorded with the ICD-code of acute coronary syndrome. All patients had survived and eventually recovered with an LV ejection fraction of 60 +/- 5 %; P = 0.03 and had had recovered normal levels of physical activity at hospital discharge. Of note is the number of women of postmenopausal age.

CONCLUSIONS: A transient cardiomyopathy triggered by major emotional stress may mimic an acute coronary syndrome but without significant coronary artery disease. This condition is characterized by reversible cardiac dysfunction and may be more frequent in women. It has a favorable clinical outcome.