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==Natural History==
{| class="wikitable"
 
!
Not all patients with [[diabetes mellitus]] suffer from diabetic nephropathy. It is estimated that 20-40% of patients with [[diabetes]] develop diabetic nephropathy. The main trigger of diabetic nephropathy is chronic [[hyperglycemia]]. However, a strict glycemic control reduces the rate at which [[microalbuminura]] appears and progress in patients with both type I and type II [[diabetes mellitus]]. However, it is debatable as to whether or not an improved blood [[glucose]] control halts the progression of renal disease once [[microalbuminuria]] is present.
!Stress Cardiomyopathy
The natural history of the disease begins with the development of [[microalbuminuria]], which usually begins 5 years after the onset of [[diabetes]]. The range for [[microalbuminura]] is 30 to 300 mg of [[albumin]] per 24 hours. Over the next 5-10 years, patients are more likely to develop overt [[proteinuria]]. Finally, over the next decade, [[nephrotic syndrome]] is more likely to occur. If left without management, diabetic nephropathy is most likely to be associated with a declining [[GFR]] and ultimately, [[end-stage renal disease]] ([[ESRD]]). At the point of [[ESRD]], [[dialysis]] and [[kidney transplantation]] are the viable options for treatment.
!Anterior Wall MI
|-
|[[Chest pain]] and [[dyspnea]] as presenting symptoms
|✔
|✔
|-
|[[ST elevation]] in [[precordial leads]]
|✔
|✔
|-
|Peak [[CK-MB]] value
|<50 U/L
|↑↑↑
|-
|6-month outcome
|Favorable outcome
|Higher rates of:
* Death
* Cardiac death
* [[Reinfarction]]
* Rehospitalization
* Major cardiac events
|}
Stress cardiomyopathy must also be differentiated from Takotsubo-like syndrome caused by medical conditions, such as [[pheochromocytoma]]:<ref name="pmid23058349">{{cite journal |vauthors=Mikail N, Hess S, Jesel L, El Ghannudi S, El Husseini Z, Trinh A, Ohlmann P, Morel O, Imperiale A |title=Takotsubo and Takotsubo-like syndrome: a common neurogenic myocardial stunning pathway? |journal=Int. J. Cardiol. |volume=166 |issue=1 |pages=248–50 |year=2013 |pmid=23058349 |doi=10.1016/j.ijcard.2012.09.116 |url=}}</ref>
{| class="wikitable"
!
!Stress Cardiomyopathy
!Takotsobu-like Syndrome
|-
|[[Chest pain]] mimicking [[MI]]
|✔
|✔
|-
|[[EKG]] findings ([[ST elevation]])
|✔
|✔
|-
|Positive [[cardiac enzymes]]
|✔
|✔
|-
|[[LV]] regional dysfunction
|✔
|✔
|-
|Patient profile
|Post-menopausal women
|Younger patients with less female predominance
|-
|[[Catecholamine]] levels
|Transient elevation
|Constantly elevated
|-
|Complications
|
|Higher rate of complications, including:
* [[Cardiogenic shock]]
* [[Heart failure]]
* Low [[Ejection fraction|ejection fraction (EF)]]
|}

Revision as of 19:52, 13 January 2017

Stress Cardiomyopathy Anterior Wall MI
Chest pain and dyspnea as presenting symptoms ✔ ✔
ST elevation in precordial leads ✔ ✔
Peak CK-MB value <50 U/L ↑↑↑
6-month outcome Favorable outcome Higher rates of:
  • Death
  • Cardiac death
  • Reinfarction
  • Rehospitalization
  • Major cardiac events

Stress cardiomyopathy must also be differentiated from Takotsubo-like syndrome caused by medical conditions, such as pheochromocytoma:[1]

Stress Cardiomyopathy Takotsobu-like Syndrome
Chest pain mimicking MI ✔ ✔
EKG findings (ST elevation) ✔ ✔
Positive cardiac enzymes ✔ ✔
LV regional dysfunction ✔ ✔
Patient profile Post-menopausal women Younger patients with less female predominance
Catecholamine levels Transient elevation Constantly elevated
Complications Higher rate of complications, including:
  1. ↑ Mikail N, Hess S, Jesel L, El Ghannudi S, El Husseini Z, Trinh A, Ohlmann P, Morel O, Imperiale A (2013). "Takotsubo and Takotsubo-like syndrome: a common neurogenic myocardial stunning pathway?". Int. J. Cardiol. 166 (1): 248–50. doi:10.1016/j.ijcard.2012.09.116. PMID 23058349.
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