symptoms of cardiomyopathy

Emotional Stress Triggers Symptoms in Hypertrophic

Cardiomyopathy: A Survey of the Hypertrophic

Cardiomyopathy Association

In the article titled: "Emotional Stress Triggers Symptoms in Hypertrophic Cardiomyopathy: A Survey of the Hypertrophic Cardiomyopathy Association " written by Rachel Lampert, Lisa Salberg, and Matthew Burg, the authors discuss symptoms as being the most important factor impacting quality of life in hypertrophic cardiomyopathy patients. They set out to create and send to several HCM patients via email, a survey. They did this so they can assess what kinds of symptoms these patients experienced with HCM. The survey also enabled patients to report emotional quality of life on a 1-10 Likert scale.

Hypothesis

The hypothesis: can emotions trigger symptoms in patients with HCM along with decreasing quality of life? As explained in the introduction by Lambert et al. (2010): "Further, emotional stressors can alter electrophysiological properties of the myocardium associated with arrhythmogenesis in other populations, suggesting that emotion could potentially be arrhythmogenic in patients with HCM, precipitating symptoms of palpitations or syncope" (LAMPERT, SALBERG, & BURG, 2010, p. 1047)

III. Sample

The participants were selected from the HCMA or Hypertrophic Cardiomyopathy Association. "The Hypertrophic Cardiomyopathy Association (HCMA) is a not-for-profit organization formed in 1996 to provide information, support, and advocacy to patients with HCM, their families, and medical providers" (LAMPERT, SALBERG, & BURG, 2010, p. 1047). The total number of respondents were 1,297 and they were given a time frame of May 2007 to November 2008 or 18 months to respond to the surveys. As mentioned before, the electronic link to the surveys were sent via email. These links were also on the HCMA message board and homepage.

The disease observed in the study is HCM or Hypertrophic Cardiomyopathy. HCM is rare in young adults with only 0.2% of the young adult population presenting the disease. The various symptoms associated with HCM are chest pain, dyspnea, palpitations, and syncope. Symptoms play a major role in determining quality of life as well as offer insight in prognosis outcome. The reason for this study was to help offer insight in how emotional stress affects individuals with HCM as not a lot of research provides information on this topic. As mentioned in the article:

The survey queried demographic and self-reported clinical information, as well as information regarding presence of symptoms (fainting / syncope, near-syncope, or lightheadedness; [grouped for analysis], chest pain; palpitations; shortness of breath) and presence of symptoms with specific activities (meals, climbing stairs, walking up a hill, lying flat, under emotional stress) (LAMPERT, SALBERG, & BURG, 2010, p. 1047).

IV. Method

LAMPERT, SALBERG, & BURG utilized the Likert scale to determine QOL or quality of life. JMP 5.0.1a was used to determine all of the statistical analyses. QOL scores were compared through the use of t-test. Logistic regression examined associations of gender and clinical factors.

V. Findings

The respondents demonstrated varied factors with 675 or 868, having HCM themselves, 19% or 250 responding for their child and 13% or 163 responding for their significant other or family member, lastly 1% or 14 respondents were answering the questions of the survey for their friend. A little over half or 58% of the respondents were male, with an average age of 44 years. The article states: "Symptoms reported included chest pain (n = 637, 49%), dyspnea (n = 906, 70%), palpitations (n = 799, 61%), and syncope or lightheadedness (n = 771, 59%)" (LAMPERT, SALBERG, & BURG, 2010, p. 1047). The results also revealed that most of the respondents reported more than one symptom. Of the symptom triggers analyzed, the most common and persistent one was exertion with 64% describing this symptom when performing any kind of strenuous activity such as climbing stairs or walking up hills.

Emotional stress played a role in how the respondents experienced symptoms with 49% stating they experienced an episode of symptoms under emotional stress. The relationship between HCM, its symptoms, and quality of life were also examined revealing several things. One such was the correlation between emotion-triggered symptoms and lower emotional and physical quality of life among the respondents. Exercise-triggered symptoms also propelled lower quality of life scores over respondents who did not have exercise triggered symptoms.

The scores from the study were: "Median reported physical QOL for the group was 7 (on a scale of 1 -- 10), (IQR 5 -- 8), emotional QOL was 8 (IQR 6 -- 9), and overall QOL was 8 (IQR 6 -- 9) only triggered symptoms were associated with lower emotional QOL" (LAMPERT, SALBERG, & BURG, 2010, p. 1047). Results also eluded that emotional-based quality of life scores were also dependent on triggered symptoms vs. non-triggered symptoms. Physical quality of life scores were dependent on presence of symptoms overall regardless of the trigger. Negative feelings were shown to play a role in triggering both AF14 and ventricular arrhythmias in with prior history providing a possible existing connection between emotional state and presence of symptoms.

Findings allowed for greater insight on the gender aspect of the respondents. The study found women were more likely to report any symptoms they may have, especially emotion-triggered symptoms. The authors of the article do not know if the difference in reporting of symptoms in terms of gender is due to:

1. "A difference in clinical presentation

2. To a difference in experience of symptoms in the presence of similar clinical findings

3. Or to a difference in the tendency to report symptoms, is unknown" (LAMPERT, SALBERG, & BURG, 2010, p. 1051).

Another study by Olivotto et al. reported a higher occurrence of symptoms in females that had HCM. The results from the Olivotto et al. study revealed advanced heart failure in women which then meant a higher possibility of progression of symptoms. The findings from both studies suggests underlying pathophysiological as well as clinical gender differences. Overall the findings suggested that the presence of symptoms and the presence of emotion or physical/exercise-triggered symptoms along with non-triggered symptoms correlated with decreased physical QOL. Triggered symptoms however, were the factors in decreased emotional QOL.

The study presented various statistics that supported their hypothesis of whether or not emotions are more likely to trigger symptoms in patients along with decreasing QOL of standards. Their results revealed emotions did have an impact on symptoms with respondents revealing emotion-triggered symptoms. The study also showed direct correlation with emotional QOL and emotional-triggered symptoms along with physical/exercise triggered symptoms. It also provided much needed insight into a field of interest few have researched.