Sympathetic nerve activity in stress-induced cardiomyopathy

Yrsa Bergmann Sverrisdóttir, Tomas Schultz, Elmir Omerovic, Mikael Elam, Yrsa Bergmann Sverrisdóttir, Tomas Schultz, Elmir Omerovic, Mikael Elam

Abstract

Purpose: To evaluate directly recorded efferent sympathetic nerve traffic in patients with stress-induced cardiomyopathy (SIC).

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Figures

Fig. 1
Fig. 1
A Sympathetic nerve activity, expressed as burst incidence (BI) in 12 patients with SIC (5 in the acute phase and 7 in the recovery phase) and 12 matched controls (*p = 0.03). B Examples of microneurographic recordings from a muscle (MSNA) and skin (SSNA) fascicle in a SIC patient in the recovery phase. The figures show a integrated neurogram of MSNA (a) and SSNA (b) in a 64-year-old female patient with MSNA BF of 17 bursts/min and SSNA BF of 27 bursts/min

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