Voorlichting bij patiënten met atriumfibrillatie : een gecontroleerde effectstudie

In outpatient care settings, there is often a lack of possibilities to inform patients sufficiently about their diagnosed disease. This is partially due to inefficient time management and a shortage of financial means. The patient is left with many unanswered questions, which can lead to uncertainty about their disease and how to deal with it. In this study the effects of a short patient education program are examined using a pre-posttest control group design and a questionnaire, the effects of a multimedia mode of patient education for patients diagnosed with atrial fibrillation are assessed on well-being, knowlegde, disease acceptance, treatment compliance, uncertainty, physical complaints, anxiety and depression. The patient education program results in a significant stronger decrease of uncertainty within the education group than in the control group. Knowledge about the disease increases significantly more in the experimental group too, compared with the control group. There is no improvement noticeable for any of the other measured variables. All in all, the results are modest, but, considering the small investment needed for such an intervention, it can be considered a valuable additional instrument in cardiology care

Voorlichting bij patiënten met atriumfibrillatie: een gecontroleerde effectstudie

In outpatient care settings, there is often a lack of possibilities to inform patients sufficiently about their diagnosed disease. This is partially due to inefficient time management and a shortage of financial means. The patient is left with many unanswered questions, which can lead to uncertainty about their disease and how to deal with it. In this study the effects of a short patient education program are examined using a pre-posttest control group design and a questionnaire, the effects of a multimedia mode of patient education for patients diagnosed with atrial fibrillation are assessed on well-being, knowlegde, disease acceptance, treatment compliance, uncertainty, physical complaints, anxiety and depression. The patient education program results in a significant stronger decrease of uncertainty within the education group than in the control group. Knowledge about the disease increases significantly more in the experimental group too, compared with the control group. There is no improvement noticeable for any of the other measured variables. All in all, the results are modest, but, considering the small investment needed for such an intervention, it can be considered a valuable additional instrument in cardiology care

Emotional, Neurohormonal, and Hemodynamic Responses to Mental Stress in Tako-Tsubo Cardiomyopathy

Tako-Tsubo cardiomyopathy (TTC) is characterized by apical ballooning of the left ventricle and symptoms and signs mimicking acute myocardial infarction. The high catecholamine levels in the acute phase of TTC and common emotional triggers suggest a dysregulated stress response system. This study examined whether patients with TTC show exaggerated emotional, neurohormonal, and hemodynamic responses to mental stress. Patients with TTC (n = 18; mean age 68.3 ± 11.7, 78% women) and 2 comparison groups (healthy controls, n = 19; mean age 60.0 ± 7.6, 68% women; chronic heart failure, n = 19; mean age 68.8 ± 10.1, 68% women) performed a structured mental stress task (anger recall and mental arithmetic) and low-grade exercise with repeated assessments of negative emotions, neurohormones (catecholamines: norepinephrine, epinephrine, dopamine, hypothalamic-pituitary-adrenal axis hormones: adrenocorticotropic hormone [ACTH], cortisol), echocardiography, blood pressure, and heart rate. TTC was associated with higher norepinephrine (520.7 ± 125.5 vs 407.9 ± 155.3 pg/ml, p = 0.021) and dopamine (16.2 ± 10.3 vs 10.3 ± 3.9 pg/ml, p = 0.027) levels during mental stress and relatively low emotional arousal (p <0.05) compared with healthy controls. During exercise, norepinephrine (511.3 ± 167.1 vs 394.4 ± 124.3 pg/ml, p = 0.037) and dopamine (17.3 ± 10.0 vs 10.8 ± 4.1 pg/ml, p = 0.017) levels were also significantly higher in patients with TTC compared with healthy controls. In conclusion, catecholamine levels during mental stress and exercise were elevated in TTC compared with healthy controls. No evidence was found for a dysregulated hypothalamic-pituitary-adrenal axis or hemodynamic responses. Patients with TTC showed blunted emotional arousal to mental stress. This study suggests that catecholamine hyper-reactivity and not emotional hyper-reactivity to stress is likely to play a role in myocardial vulnerability in TTC. Tako-Tsubo cardiomyopathy (TTC) is characterized by apical ballooning of the left ventricle (LV) and symptoms and signs mimicking acute myocardial infarction.1, 2 and 3 Emotional triggers are common in TTC,4 and the high catecholamine levels on admission1 suggest a dysregulated stress response system. This study examined emotional, neurohormonal, and hemodynamic responses to acute mental stress, comparing patients with TTC to healthy controls and cardiac patients with heart failure (HF). We investigated whether emotional, neurohormonal (catecholamines and hypothalamic-pituitary-adrenal [HPA]-related measures adrenocorticotropic hormone [ACTH] and cortisol), and hemodynamic (LV function, blood pressure, and heart rate [HR]) responses to a structured mental stress task are exaggerated in patients with a history of TTC compared with healthy controls and patient controls with stable HF. We also examined potential response patterns to low-grade exercise challenge for comparison purposes

Is it possible to differentiate between Takotsubo cardiomyopathy and acute anterior ST-elevation myocardial infarction?

Introduction Several studies have investigated the ability of the twelve-lead electrocardiogram (ECG) to reliably distinguish Takotsubo cardiomyopathy (TC) from an acute anterior ST-segment elevation myocardial infarction (STEMI). In these studies, only ECG changes were required – ST-segment deviation and/or T-wave inversion – in TC whereas in acute anterior STEMI, ECGs had to meet STEMI criteria. In the majority of these studies, patients of both genders were used even though TC predominantly occurs in women. The aim of this study is to see whether TC can be distinguished from acute anterior STEMI in a predominantly female study population where all patients meet STEMI-criteria. Methods Retrospective analysis of the ST-segment changes was done on the triage ECGs of 37 patients with TC (34 female) and was compared to the triage ECGs of 103 female patients with acute anterior STEMI. The latter group was divided into the following subgroups: 46 patients with proximal, 47 with mid and 10 with distal LAD occlusion. Three ST-segment based ECG features were investigated: (1) Existing criterion for differentiating anterior STEMI from TC: ST-segment depression > 0.5 mm in lead aVR + ST-segment elevation ≤ 1 mm in lead V1, (2) frontal plane ST-vector and (3) mean amplitude of ST-segment deviation in each lead. Results The existing ECG criterion was less accurate (76%) than in the original study (95%), with a large difference in sensitivity (26% vs. 91%). Only a frontal plane ST-vector of 60° could significantly distinguish TC from all acute anterior STEMI subgroups (p < 0.01) with an overall diagnostic accuracy of 81%. The mean amplitude in inferior leads II and aVF was significantly higher for patients with TC compared to all patients with acute anterior STEMI (p < 0.01 and p < 0.05 respectively) and the mean amplitude in the precordial leads V1 and V2 was significantly lower compared to proximal and mid LAD occlusion (p < 0.01). Conclusions Given the consequences of missing the diagnosis of an acute anterior STEMI the diagnostic accuracy of the ECG criteria investigated in this retrospective study were insufficient to reliably distinguish patients with TC from patients with an acute anterior STEMI. To definitely exclude the diagnosis of an acute anterior STEMI coronary angiography, which remains the gold standard, will need to be performed.Keywords: Acute coronary syndrome, Takotsubo cardiomyopathy, Acute anterior myocardial infarctio