Subject(s)
Angiotensin-Converting Enzyme Inhibitors/administration & dosage , Diuretics/administration & dosage , Pneumonia , Sepsis , Takotsubo Cardiomyopathy , Ventricular Dysfunction, Left/diagnostic imaging , Adrenalectomy/adverse effects , Adrenalectomy/methods , Coronary Angiography/methods , Diagnosis, Differential , Echocardiography/methods , Electrocardiography/methods , Female , Humans , Middle Aged , Patient Care Management/methods , Pituitary ACTH Hypersecretion/surgery , Pneumonia/complications , Pneumonia/diagnosis , Pneumonia/drug therapy , Sepsis/diagnosis , Sepsis/etiology , Sepsis/physiopathology , Sepsis/therapy , Takotsubo Cardiomyopathy/diagnosis , Takotsubo Cardiomyopathy/drug therapy , Takotsubo Cardiomyopathy/etiology , Takotsubo Cardiomyopathy/physiopathology , Treatment OutcomeABSTRACT
BACKGROUND: Studies have recognized myocardial infarction (MI) as a risk for acute stress disorder (ASD), manifested in dissociative, intrusive, avoidant, and hyperarousal symptoms during hospitalization. PURPOSE: This study examined the prognostic role of ASD symptoms in predicting all-cause mortality in MI patients over a period of 15 years. METHODS: One hundred and ninety-three MI patients filled out questionnaires assessing ASD symptoms during hospitalization. Risk factors and cardiac prognostic measures were collected from patients' hospital records. All-cause mortality was longitudinally assessed, with an endpoint of 15 years after the MI. RESULTS: Of the participants, 21.8 % died during the follow-up period. The decedents had reported higher levels of ASD symptoms during hospitalization than had the survivors, but this effect became nonsignificant when adjusting for age, sex, education, left ventricular ejection fraction, and depression. A series of analyses conducted on each of the ASD symptom clusters separately indicated that-after adjusting for age, sex, education, left ventricular ejection fraction, and depression-dissociative symptoms significantly predicted all-cause mortality, indicating that the higher the level of in-hospital dissociative symptoms, the shorter the MI patients' survival time. CONCLUSION: These findings suggest that in-hospital dissociative symptoms should be considered in the risk stratification of MI patients.
Subject(s)
Myocardial Infarction/mortality , Stress Disorders, Traumatic, Acute/diagnosis , Female , Follow-Up Studies , Humans , Longitudinal Studies , Male , Middle Aged , Myocardial Infarction/complications , Myocardial Infarction/psychology , Predictive Value of Tests , Prognosis , Risk Factors , Stress Disorders, Traumatic, Acute/etiology , Stress Disorders, Traumatic, Acute/mortality , Stress Disorders, Traumatic, Acute/psychology , Symptom AssessmentABSTRACT
BACKGROUND: This study examines the trajectories of posttraumatic stress disorder (PTSD) following myocardial infarction (MI). More specifically, it has 2 aims: (1) to examine whether the trajectory of PTSD is predicted by level of threat and the nature of initial reactions and (2) to examine the associations between the trajectory of PTSD and anxiety, somatization, health-related quality of life, and hospitalization 7 months following MI. METHOD: 116 MI patients were examined twice. At time 1, within a week of the patient's MI, acute stress disorder (ASD) was assessed and medical measures were obtained from patients' hospital records. At time 2, 7 months later, PTSD, anxiety, physical residuals, and health-related quality of life were assessed. Data were gathered in 1999. RESULTS: Six percent of the respondents had both ASD and PTSD, 10% did not have ASD but did have PTSD, and 12% had ASD but not PTSD. The trajectory of PTSD was associated with severity of anxiety, somatic complaints, and health-related quality of life. In addition, while the severity of MI did not predict the trajectory of PTSD, the perceived severity did. Patients without PTSD but with prior ASD did not differ in their initial reactions from those without ASD. CONCLUSION: These findings provide support for the considerable variability in the trajectory of the development of PTSD and suggest that although ASD is associated with subsequent PTSD, the predictive role of initial reactions is limited.
Subject(s)
Myocardial Infarction/psychology , Stress Disorders, Post-Traumatic/diagnosis , Aged , Anxiety Disorders/diagnosis , Anxiety Disorders/epidemiology , Anxiety Disorders/psychology , Comorbidity , Cross-Sectional Studies , Female , Follow-Up Studies , Humans , Israel , Male , Middle Aged , Myocardial Infarction/epidemiology , Patient Readmission/statistics & numerical data , Personality Inventory , Quality of Life/psychology , Sick Role , Somatoform Disorders/diagnosis , Somatoform Disorders/epidemiology , Somatoform Disorders/psychology , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychologyABSTRACT
We describe a hypertensive patient who developed profound cardiogenic shock after treatment with nitrates and diuretics. Echocardiography revealed a marked left ventricular outflow tract obstruction with severe mitral regurgitation that were reversible after aggressive fluid therapy.
