Clinical Reviews
Medwave 2016 Jun;16(5) doi: 10.5867/medwave.2016.05.6460
Psychological disorders in adults with inherited cardiomyopathies and Takotsubo syndrome
Mariana Suárez Bagnasco , Iván J. Núñez-Gil
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Key Words: inherited cardiomyopathies, Takotsubo syndrome, psychological disorders, adults

Resumen

Realizamos una revisión narrativa sobre trastornos psicológicos en adultos con diagnóstico de síndrome de Takotsubo y miocardiopatías hereditarias. Utilizando las bases de datos PubMed y PsycINFO buscamos los trabajos relevantes publicados entre 2000 y 2015. Encontramos doce estudios que exploran alteraciones psicológicas en síndrome de Takotsubo y ocho estudios sobre miocardiopatías hereditarias: cinco enrolaron pacientes con miocardiopatía hipertrófica, dos miocardiopatía dilatada, uno miocardiopatía arritmogénica del ventrículo derecho. Todas las publicaciones reportaron la presencia de trastornos psicológicos. En el síndrome de Takotsubo, la depresión oscila entre el 20,5 y el 48% y la ansiedad estuvo presente entre el 26 y el 56%. Un estudio reporta que la ansiedad aumenta la probabilidad de desarrollar el síndrome de Takotsubo. En la miocardiopatía dilatada, la ansiedad estuvo presente en el 50% de los pacientes y la depresión en el 22%. En la miocardiopatía arritmogénica del ventrículo derecho, la edad más joven, peor capacidad funcional y haber experimentado al menos un shock por desfibrilador automático implantable, fueron predictores independientes significativos de ansiedad tanto específica por el dispositivo como generalizada. En la miocardiopatía hipertrófica, la ansiedad y la depresión estaban presentes en 45,2% y 17,9%, respectivamente. Treinta y siete por ciento cumplía con los criterios de diagnóstico para los trastornos de ansiedad y 21% para los trastornos del estado de ánimo. Cerca de la mitad de los pacientes con miocardiopatía hipertrófica informan dolor en el pecho, disnea y mareos desencadenados por estrés emocional. Debido al reducido número de estudios publicados, las conclusiones son limitadas. No obstante, presentamos algunos de los resultados.


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Realizamos una revisión narrativa sobre trastornos psicológicos en adultos con diagnóstico de síndrome de Takotsubo y miocardiopatías hereditarias. Utilizando las bases de datos PubMed y PsycINFO buscamos los trabajos relevantes publicados entre 2000 y 2015. Encontramos doce estudios que exploran alteraciones psicológicas en síndrome de Takotsubo y ocho estudios sobre miocardiopatías hereditarias: cinco enrolaron pacientes con miocardiopatía hipertrófica, dos miocardiopatía dilatada, uno miocardiopatía arritmogénica del ventrículo derecho. Todas las publicaciones reportaron la presencia de trastornos psicológicos. En el síndrome de Takotsubo, la depresión oscila entre el 20,5 y el 48% y la ansiedad estuvo presente entre el 26 y el 56%. Un estudio reporta que la ansiedad aumenta la probabilidad de desarrollar el síndrome de Takotsubo. En la miocardiopatía dilatada, la ansiedad estuvo presente en el 50% de los pacientes y la depresión en el 22%. En la miocardiopatía arritmogénica del ventrículo derecho, la edad más joven, peor capacidad funcional y haber experimentado al menos un shock por desfibrilador automático implantable, fueron predictores independientes significativos de ansiedad tanto específica por el dispositivo como generalizada. En la miocardiopatía hipertrófica, la ansiedad y la depresión estaban presentes en 45,2% y 17,9%, respectivamente. Treinta y siete por ciento cumplía con los criterios de diagnóstico para los trastornos de ansiedad y 21% para los trastornos del estado de ánimo. Cerca de la mitad de los pacientes con miocardiopatía hipertrófica informan dolor en el pecho, disnea y mareos desencadenados por estrés emocional. Debido al reducido número de estudios publicados, las conclusiones son limitadas. No obstante, presentamos algunos de los resultados.

Authors: Mariana Suárez Bagnasco [1], Iván J. Núñez-Gil [2]

Affiliation:
[1] Universidad Católica del Uruguay, Montevideo, Uruguay
[2] Servicio de Cardiología, Hospital Clínico Universitario San Carlos, Madrid, España

E-mail: mariansb@gmail.com

Author address:
[1] Universidad Católica del Uruguay
Avenida 8 de octubre 2738
Montevideo
Uruguay

Citation: Suárez Bagnasco M, Núñez-Gil IJ . Psychological disorders in adults with inherited cardiomyopathies and Takotsubo syndrome. Medwave 2016 Jun;16(5) doi: 10.5867/medwave.2016.05.6460

Submission date: 27/3/2016

Acceptance date: 26/5/2016

Publication date: 3/6/2016

Origin: not requested

Type of review: reviewed by three external peer reviewers, double-blind

PubMed record

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  1. Watkins H, Ashrafian H, Redwood C. Inherited cardiomyopathies. N Engl J Med. 2011 Apr 28;364(17):1643-56. | CrossRef | PubMed |
  2. Rapezzi C, Arbustini E, Caforio AL, Charron P, Gimeno-Blanes J, Heliö T, et al. Diagnostic work-up in cardiomyopathies: bridging the gap between clinical phenotypes and final diagnosis. A position statement from the ESC Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013 May;34(19):1448-58. | CrossRef | PubMed |
  3. Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, Charron P, . Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2008 Jan;29(2):270-6. | PubMed |
  4. Hughes SE, McKenna WJ. New insights into the pathology of inherited cardiomyopathy. Heart. 2005 Feb;91(2):257-64. | PubMed |
  5. Jacoby D, McKenna WJ. Genetics of inherited cardiomyopathy. Eur Heart J. 2012 Feb;33(3):296-304. | CrossRef | PubMed |
  6. Merli E, Sutcliffe S, Gori M, Sutherland GG. Tako-Tsubo cardiomyopathy: new insights into the possible underlying pathophysiology. Eur J Echocardiogr. 2006 Jan;7(1):53-61. | PubMed |
  7. Ribeiro VF, Vasconcelos M, Melão F, Ferreira E, Malangatana G, Maciel MJ. Short and long-term outcome of stress-induced cardiomyopathy: what can we expect? Arq Bras Cardiol. 2014 Jan;102(1):80-5. | CrossRef | PubMed |
  8. Sharkey SW, Lesser JR, Maron BJ. Cardiology Patient Page. Takotsubo (stress) cardiomyopathy. Circulation. 2011 Nov 1;124(18):e460-2. | CrossRef | PubMed |
  9. Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005 Feb 10;352(6):539-48. | PubMed |
  10. Vidi V, Rajesh V, Singh PP, Mukherjee JT, Lago RM, Venesy DM, et al. Clinical characteristics of tako-tsubo cardiomyopathy. Am J Cardiol. 2009 Aug 15;104(4):578-82. | CrossRef | PubMed |
  11. Gianni M, Dentali F, Grandi AM, Sumner G, Hiralal R, Lonn E. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J. 2006 Jul;27(13):1523-9. Epub 2006 May 23. | PubMed |
  12. Lyon AR, Rees PS, Prasad S, Poole-Wilson PA, Harding SE. Stress (Takotsubo) cardiomyopathy--a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nat Clin Pract Cardiovasc Med. 2008 Jan;5(1):22-9. | PubMed |
  13. Kurisu S, Sato H, Kawagoe T, Ishihara M, Shimatani Y, Nishioka K, et al. Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. Am Heart J. 2002 Mar;143(3):448-55. | PubMed |
  14. Abe Y, Kondo M, Matsuoka R, Araki M, Dohyama K, Tanio H. Assessment of clinical features in transient left ventricular apical ballooning. J Am Coll Cardiol. 2003 Mar 5;41(5):737-42. | PubMed |
  15. Abe Y, Kondo M, Matsuoka R, Araki M, Dohyama K, Tanio H. Assessment of clinical features in transient left ventricular apical ballooning. J Am Coll Cardiol. 2003 Mar 5;41(5):737-42. | PubMed |
  16. Kawai S, Kitabatake A, Tomoike H; Takotsubo Cardiomyopathy Group. Guidelines for diagnosis of takotsubo (ampulla) cardiomyopathy. Circ J. 2007 Jun;71(6):990-2. | PubMed |
  17. Nef HM, Möllmann H, Kostin S, Troidl C, Voss S, Weber M, et al. Tako-Tsubo cardiomyopathy: intraindividual structural analysis in the acute phase and after functional recovery. Eur Heart J. 2007 Oct;28(20):2456-64. | PubMed |
  18. Akashi YJ, Nef HM, Möllmann H, Ueyama T. Stress cardiomyopathy. Annu Rev Med. 2010;61:271-86. | CrossRef | PubMed |
  19. Núñez-Gil IJ, Luaces Méndez M, García-Rubira JC. Cardiopatía de estrés o síndrome de Tako-Tsubo: conceptos actuales. Rev Argent Cardiol 2009;77:218-223. | Link |
  20. Núñez-Gil IJ, Bernardo E, Feltes G, Escaned J, Mejía-Rentería HD, De Agustín JA, et al. Platelet function in Takotsubo cardiomyopathy. J Thromb Thrombolysis. 2015 May;39(4):452-8. | CrossRef | PubMed |
  21. Kastaun S, Schwarz NP, Juenemann M, Yeniguen M, Nef HM, Moellmann H, et al. Cortisol awakening and stress response, personality and psychiatric profiles in patients with takotsubo cardiomyopathy. Heart. 2014 Nov;100(22):1786-92. | CrossRef | PubMed |
  22. Deshmukh A, Kumar G, Pant S, Rihal C, Murugiah K, Mehta JL. Prevalence of Takotsubo cardiomyopathy in the United States. Am Heart J. 2012 Jul;164(1):66-71.e1. | CrossRef | PubMed |
  23. Sharkey SW, Windenburg DC, Lesser JR, Maron MS, Hauser RG, Lesser JN, et al. Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy. J Am Coll Cardiol. 2010 Jan 26;55(4):333-41. | CrossRef | PubMed |
  24. Summers MR, Lennon RJ, Prasad A. Pre-morbid psychiatric and cardiovascular diseases in apical ballooning syndrome (tako-tsubo/stress-induced cardiomyopathy): potential pre-disposing factors? J Am Coll Cardiol. 2010 Feb 16;55(7):700-1. | CrossRef | PubMed |
  25. Dias A, Franco E, Mercedes A, Hebert K, Messina D, Quevedo HC. Clinical features of takotsubo cardiomyopathy - a single-center experience. Cardiology. 2013;126(2):126-30. | CrossRef | PubMed |
  26. Waldenborg M, Soholat M, Kähäri A, Emilsson K, Fröbert O. Multidisciplinary assessment of tako tsubo cardiomyopathy: a prospective case study. BMC Cardiovasc Disord. 2011 Apr 9;11:14. | CrossRef | PubMed |
  27. Compare A, Bigi R, Orrego PS, Proietti R, Grossi E, Steptoe A. Type D personality is associated with the development of stress cardiomyopathy following emotional triggers. Ann Behav Med. 2013 Jun;45(3):299-307. | CrossRef | PubMed |
  28. Del Pace S, Parodi G, Bellandi B, Zampini L, Venditti F, Ardito M, et al. Anxiety trait in patients with stress-induced cardiomyopathy: a case-control study. Clin Res Cardiol. 2011 Jun;100(6):523-9. | CrossRef | PubMed |
  29. Lacey C, Mulder R, Bridgman P, Kimber B, Zarifeh J, Kennedy M, Cameron V. Broken heart syndrome -- is it a psychosomatic disorder? J Psychosom Res. 2014 Aug;77(2):158-60. | CrossRef | PubMed |
  30. Delmas C, Lairez O, Mulin E, Delmas T, Boudou N, Dumonteil N, Biendel-Picquet C, et al. Anxiodepressive disorders and chronic psychological stress are associated with Tako-Tsubo cardiomyopathy- New Physiopathological Hypothesis. Circ J. 2013;77(1):175-80. | PubMed |
  31. El-Sayed AM, Brinjikji W, Salka S. Demographic and co-morbid predictors of stress (takotsubo) cardiomyopathy. Am J Cardiol. 2012 Nov 1;110 (9):1368-72. | CrossRef | PubMed |
  32. Sharkey SW, Maron BJ. Epidemiology and clinical profile of Takotsubo cardiomyopathy. Circ J. 2014;78(9):2119-28. | PubMed |
  33. Compare A, Grossi E, Bigi R, Proietti R, Shonin E, Orrego PS, Poole L. Stress-induced cardiomyopathy and psychological wellbeing 1 year after an acute event. J Clin Psychol Med Settings. 2014 Mar;21(1):81-91. | CrossRef | PubMed |
  34. Ingles J, Lind JM, Phongsavan P, Semsarian C. Psychosocial impact of specialized cardiac genetic clinics for hypertrophic cardiomyopathy. Genet Med. 2008 Feb;10(2):117-20. | CrossRef | PubMed |
  35. Serber ER, Sears SF, Nielsen CD, Spencer WH 3rd, Smith KM. Depression, anxiety, and quality of life in patients with obstructive hypertrophic cardiomyopathy three months after alcohol septal ablation. Am J Cardiol. 2007 Nov 15;100(10):1592-7. | PubMed |
  36. Lampert R, Salberg L, Burg M. Emotional stress triggers symptoms in hypertrophic cardiomyopathy: a survey of the Hypertrophic Cardiomyopathy Association. Pacing Clin Electrophysiol. 2010 Sep;33(9):1047-53. | CrossRef | PubMed |
  37. Morgan JF, O'Donoghue AC, McKenna WJ, Schmidt MM. Psychiatric disorders in hypertrophic cardiomyopathy. Gen Hosp Psychiatry. 2008 Jan-Feb;30 (1):49-54. | CrossRef | PubMed |
  38. Igoumenou A, Alevizopoulos G, Anastasakis A, Stavrakaki E, Toutouzas P, Stefanadis C. Depression in patients with hypertrophic cardiomyopathy: is there any relation with the risk factors for sudden death? Heart Asia 2012;4:44-48. | CrossRef |
  39. Griez EJ, Mammar N, Loirat JC, Djega N, Trochut JN, Bouhour JB. Panic disorder and idiopathic cardiomyopathy. J Psychosom Res. 2000 Jun;48(6):585-7. | PubMed |
  40. Steptoe A, Mohabir A, Mahon NG, McKenna WJ. Health related quality of life and psychological wellbeing in patients with dilated cardiomyopathy. Heart. 2000;83(6):645-50. | PubMed |
  41. James CA, Tichnell C, Murray B, Daly A, Sears SF, Calkins H. General and disease-specific psychosocial adjustment in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy with implantable cardioverter defibrillators: a large cohort study. Circ Cardiovasc Genet. 2012 Feb 1;5(1):18-24. | CrossRef | PubMed |
  42. Habibović M, Pedersen SS, van den Broek KC, Theuns DA, Jordaens L, van der Voort PH, et al. Anxiety and risk of ventricular arrhythmias or mortality in patients with an implantable cardioverter defibrillator. Psychosom Med. 2013 Jan;75(1):36-41. | CrossRef | PubMed |
  43. Lombardi F, Porta A, Marzegalli M, Favale S, Santini M, Vincenti A, et al. Heart rate variability patterns before ventricular tachycardia onset in patients with an implantable cardioverter defibrillator. Participating Investigators of ICD-HRV Italian Study Group. Am J Cardiol. 2000 Nov 1;86(9):959-63. | PubMed |
  44. Dishman RK, Nakamura Y, Garcia ME, Thompson RW, Dunn AL, Blair SN. Heart rate variability, trait anxiety, and perceived stress among physically fit men and women. Int J Psychophysiol. 2000 Aug;37(2):121-33. | PubMed |
  45. Lefroy DC, de Silva R, Choudhury L, Uren NG, Crake T, Rhodes CG, et al. Diffuse reduction of myocardial beta-adrenoceptors in hypertrophic cardiomyopathy: a study with positron emission tomography. J Am Coll Cardiol. 1993 Nov 15;22(6):1653-60. | PubMed |
  46. Schäfers M, Dutka D, Rhodes CG, Lammertsma AA, Hermansen F, Schober O, Camici PG. Myocardial presynaptic and postsynaptic autonomic dysfunction in hypertrophic cardiomyopathy. Circ Res. 1998 Jan 9-23;82(1):57-62. | PubMed |
Watkins H, Ashrafian H, Redwood C. Inherited cardiomyopathies. N Engl J Med. 2011 Apr 28;364(17):1643-56. | CrossRef | PubMed |

Rapezzi C, Arbustini E, Caforio AL, Charron P, Gimeno-Blanes J, Heliö T, et al. Diagnostic work-up in cardiomyopathies: bridging the gap between clinical phenotypes and final diagnosis. A position statement from the ESC Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013 May;34(19):1448-58. | CrossRef | PubMed |

Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, Charron P, . Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2008 Jan;29(2):270-6. | PubMed |

Hughes SE, McKenna WJ. New insights into the pathology of inherited cardiomyopathy. Heart. 2005 Feb;91(2):257-64. | PubMed |

Jacoby D, McKenna WJ. Genetics of inherited cardiomyopathy. Eur Heart J. 2012 Feb;33(3):296-304. | CrossRef | PubMed |

Merli E, Sutcliffe S, Gori M, Sutherland GG. Tako-Tsubo cardiomyopathy: new insights into the possible underlying pathophysiology. Eur J Echocardiogr. 2006 Jan;7(1):53-61. | PubMed |

Ribeiro VF, Vasconcelos M, Melão F, Ferreira E, Malangatana G, Maciel MJ. Short and long-term outcome of stress-induced cardiomyopathy: what can we expect? Arq Bras Cardiol. 2014 Jan;102(1):80-5. | CrossRef | PubMed |

Sharkey SW, Lesser JR, Maron BJ. Cardiology Patient Page. Takotsubo (stress) cardiomyopathy. Circulation. 2011 Nov 1;124(18):e460-2. | CrossRef | PubMed |

Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005 Feb 10;352(6):539-48. | PubMed |

Vidi V, Rajesh V, Singh PP, Mukherjee JT, Lago RM, Venesy DM, et al. Clinical characteristics of tako-tsubo cardiomyopathy. Am J Cardiol. 2009 Aug 15;104(4):578-82. | CrossRef | PubMed |

Gianni M, Dentali F, Grandi AM, Sumner G, Hiralal R, Lonn E. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J. 2006 Jul;27(13):1523-9. Epub 2006 May 23. | PubMed |

Lyon AR, Rees PS, Prasad S, Poole-Wilson PA, Harding SE. Stress (Takotsubo) cardiomyopathy--a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nat Clin Pract Cardiovasc Med. 2008 Jan;5(1):22-9. | PubMed |

Kurisu S, Sato H, Kawagoe T, Ishihara M, Shimatani Y, Nishioka K, et al. Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. Am Heart J. 2002 Mar;143(3):448-55. | PubMed |

Abe Y, Kondo M, Matsuoka R, Araki M, Dohyama K, Tanio H. Assessment of clinical features in transient left ventricular apical ballooning. J Am Coll Cardiol. 2003 Mar 5;41(5):737-42. | PubMed |

Abe Y, Kondo M, Matsuoka R, Araki M, Dohyama K, Tanio H. Assessment of clinical features in transient left ventricular apical ballooning. J Am Coll Cardiol. 2003 Mar 5;41(5):737-42. | PubMed |

Kawai S, Kitabatake A, Tomoike H; Takotsubo Cardiomyopathy Group. Guidelines for diagnosis of takotsubo (ampulla) cardiomyopathy. Circ J. 2007 Jun;71(6):990-2. | PubMed |

Nef HM, Möllmann H, Kostin S, Troidl C, Voss S, Weber M, et al. Tako-Tsubo cardiomyopathy: intraindividual structural analysis in the acute phase and after functional recovery. Eur Heart J. 2007 Oct;28(20):2456-64. | PubMed |

Akashi YJ, Nef HM, Möllmann H, Ueyama T. Stress cardiomyopathy. Annu Rev Med. 2010;61:271-86. | CrossRef | PubMed |

Núñez-Gil IJ, Luaces Méndez M, García-Rubira JC. Cardiopatía de estrés o síndrome de Tako-Tsubo: conceptos actuales. Rev Argent Cardiol 2009;77:218-223. | Link |

Núñez-Gil IJ, Bernardo E, Feltes G, Escaned J, Mejía-Rentería HD, De Agustín JA, et al. Platelet function in Takotsubo cardiomyopathy. J Thromb Thrombolysis. 2015 May;39(4):452-8. | CrossRef | PubMed |

Kastaun S, Schwarz NP, Juenemann M, Yeniguen M, Nef HM, Moellmann H, et al. Cortisol awakening and stress response, personality and psychiatric profiles in patients with takotsubo cardiomyopathy. Heart. 2014 Nov;100(22):1786-92. | CrossRef | PubMed |

Deshmukh A, Kumar G, Pant S, Rihal C, Murugiah K, Mehta JL. Prevalence of Takotsubo cardiomyopathy in the United States. Am Heart J. 2012 Jul;164(1):66-71.e1. | CrossRef | PubMed |

Sharkey SW, Windenburg DC, Lesser JR, Maron MS, Hauser RG, Lesser JN, et al. Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy. J Am Coll Cardiol. 2010 Jan 26;55(4):333-41. | CrossRef | PubMed |

Summers MR, Lennon RJ, Prasad A. Pre-morbid psychiatric and cardiovascular diseases in apical ballooning syndrome (tako-tsubo/stress-induced cardiomyopathy): potential pre-disposing factors? J Am Coll Cardiol. 2010 Feb 16;55(7):700-1. | CrossRef | PubMed |

Dias A, Franco E, Mercedes A, Hebert K, Messina D, Quevedo HC. Clinical features of takotsubo cardiomyopathy - a single-center experience. Cardiology. 2013;126(2):126-30. | CrossRef | PubMed |

Waldenborg M, Soholat M, Kähäri A, Emilsson K, Fröbert O. Multidisciplinary assessment of tako tsubo cardiomyopathy: a prospective case study. BMC Cardiovasc Disord. 2011 Apr 9;11:14. | CrossRef | PubMed |

Compare A, Bigi R, Orrego PS, Proietti R, Grossi E, Steptoe A. Type D personality is associated with the development of stress cardiomyopathy following emotional triggers. Ann Behav Med. 2013 Jun;45(3):299-307. | CrossRef | PubMed |

Del Pace S, Parodi G, Bellandi B, Zampini L, Venditti F, Ardito M, et al. Anxiety trait in patients with stress-induced cardiomyopathy: a case-control study. Clin Res Cardiol. 2011 Jun;100(6):523-9. | CrossRef | PubMed |

Lacey C, Mulder R, Bridgman P, Kimber B, Zarifeh J, Kennedy M, Cameron V. Broken heart syndrome -- is it a psychosomatic disorder? J Psychosom Res. 2014 Aug;77(2):158-60. | CrossRef | PubMed |

Delmas C, Lairez O, Mulin E, Delmas T, Boudou N, Dumonteil N, Biendel-Picquet C, et al. Anxiodepressive disorders and chronic psychological stress are associated with Tako-Tsubo cardiomyopathy- New Physiopathological Hypothesis. Circ J. 2013;77(1):175-80. | PubMed |

El-Sayed AM, Brinjikji W, Salka S. Demographic and co-morbid predictors of stress (takotsubo) cardiomyopathy. Am J Cardiol. 2012 Nov 1;110 (9):1368-72. | CrossRef | PubMed |

Sharkey SW, Maron BJ. Epidemiology and clinical profile of Takotsubo cardiomyopathy. Circ J. 2014;78(9):2119-28. | PubMed |

Compare A, Grossi E, Bigi R, Proietti R, Shonin E, Orrego PS, Poole L. Stress-induced cardiomyopathy and psychological wellbeing 1 year after an acute event. J Clin Psychol Med Settings. 2014 Mar;21(1):81-91. | CrossRef | PubMed |

Ingles J, Lind JM, Phongsavan P, Semsarian C. Psychosocial impact of specialized cardiac genetic clinics for hypertrophic cardiomyopathy. Genet Med. 2008 Feb;10(2):117-20. | CrossRef | PubMed |

Serber ER, Sears SF, Nielsen CD, Spencer WH 3rd, Smith KM. Depression, anxiety, and quality of life in patients with obstructive hypertrophic cardiomyopathy three months after alcohol septal ablation. Am J Cardiol. 2007 Nov 15;100(10):1592-7. | PubMed |

Lampert R, Salberg L, Burg M. Emotional stress triggers symptoms in hypertrophic cardiomyopathy: a survey of the Hypertrophic Cardiomyopathy Association. Pacing Clin Electrophysiol. 2010 Sep;33(9):1047-53. | CrossRef | PubMed |

Morgan JF, O'Donoghue AC, McKenna WJ, Schmidt MM. Psychiatric disorders in hypertrophic cardiomyopathy. Gen Hosp Psychiatry. 2008 Jan-Feb;30 (1):49-54. | CrossRef | PubMed |

Igoumenou A, Alevizopoulos G, Anastasakis A, Stavrakaki E, Toutouzas P, Stefanadis C. Depression in patients with hypertrophic cardiomyopathy: is there any relation with the risk factors for sudden death? Heart Asia 2012;4:44-48. | CrossRef |

Griez EJ, Mammar N, Loirat JC, Djega N, Trochut JN, Bouhour JB. Panic disorder and idiopathic cardiomyopathy. J Psychosom Res. 2000 Jun;48(6):585-7. | PubMed |

Steptoe A, Mohabir A, Mahon NG, McKenna WJ. Health related quality of life and psychological wellbeing in patients with dilated cardiomyopathy. Heart. 2000;83(6):645-50. | PubMed |

James CA, Tichnell C, Murray B, Daly A, Sears SF, Calkins H. General and disease-specific psychosocial adjustment in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy with implantable cardioverter defibrillators: a large cohort study. Circ Cardiovasc Genet. 2012 Feb 1;5(1):18-24. | CrossRef | PubMed |

Habibović M, Pedersen SS, van den Broek KC, Theuns DA, Jordaens L, van der Voort PH, et al. Anxiety and risk of ventricular arrhythmias or mortality in patients with an implantable cardioverter defibrillator. Psychosom Med. 2013 Jan;75(1):36-41. | CrossRef | PubMed |

Lombardi F, Porta A, Marzegalli M, Favale S, Santini M, Vincenti A, et al. Heart rate variability patterns before ventricular tachycardia onset in patients with an implantable cardioverter defibrillator. Participating Investigators of ICD-HRV Italian Study Group. Am J Cardiol. 2000 Nov 1;86(9):959-63. | PubMed |

Dishman RK, Nakamura Y, Garcia ME, Thompson RW, Dunn AL, Blair SN. Heart rate variability, trait anxiety, and perceived stress among physically fit men and women. Int J Psychophysiol. 2000 Aug;37(2):121-33. | PubMed |

Lefroy DC, de Silva R, Choudhury L, Uren NG, Crake T, Rhodes CG, et al. Diffuse reduction of myocardial beta-adrenoceptors in hypertrophic cardiomyopathy: a study with positron emission tomography. J Am Coll Cardiol. 1993 Nov 15;22(6):1653-60. | PubMed |

Schäfers M, Dutka D, Rhodes CG, Lammertsma AA, Hermansen F, Schober O, Camici PG. Myocardial presynaptic and postsynaptic autonomic dysfunction in hypertrophic cardiomyopathy. Circ Res. 1998 Jan 9-23;82(1):57-62. | PubMed |