title: Emotional stress triggers symptoms in hypertrophic cardiomyopathy: a survey of the Hypertrophic Cardiomyopathy Association.
abstract: BACKGROUND
  Symptoms are among the most important factors impacting quality of life (QOL) in hypertrophic cardiomyopathy (HCM) patients, and reflect a poor prognosis. Whether emotional stress can trigger symptoms of chest pain, dyspnea, palpitations, and lightheadedness has not been described.
  
  
  METHODS
  Members of the Hypertrophic Cardiomyopathy Association (HCMA) received an electronic link via e-mail to an ongoing online survey, also accessed via links on the HCMA message-board and homepage. Between May 2007 and November 2008, there were 1,297 respondents. The survey queried demographic and self-reported clinical information, and types and triggers of symptoms. Respondents reported physical and emotional QOL on a 1-10 Likert scale.
  
  
  RESULTS
  Symptoms reported included chest pain (49%), dyspnea (70%), palpitations (61%), and syncope/lightheadedness (59%). The most common symptom trigger was exertion, 64% describing symptoms while climbing stairs or hills. Forty-nine percent described experiencing symptoms during emotional stress. Those reporting chest pain were more likely to report emotion triggering (60%) than those reporting palpitations, syncope/lightheadedness, or dyspnea (50-54% each). Both physical and emotional QOL were significantly decreased in those describing emotion-triggered symptoms. Women were more likely than men to report symptoms overall, as well as emotion-triggered symptoms (50% vs 35%, P < 0.001) and exertion-triggered symptoms (79% vs 58%, P < 0.001). After controlling for presence of symptoms, both emotion- and exertion-triggered symptoms remained significantly more common in women.
  
  
  CONCLUSIONS
  Triggering of symptoms by emotion is common in individuals with HCM. Further studies will determine pathways linking emotional stressors with chest pain, dyspnea, palpitations, and lightheadedness in these patients.
authors.affiliation: Yale University School of Medicine, Department of Internal Medicine, New Haven, CT, USA. rachel.lampert@yale.edu
authors.forename: Rachel
authors.initials: R
authors.lastname: Lampert
authors.forename: Lisa
authors.initials: L
authors.lastname: Salberg
authors.forename: Matthew
authors.initials: M
authors.lastname: Burg
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000503:physiopathology / Q000523:psychology; D002312:Cardiomyopathy, Hypertrophic / Q000503:physiopathology* / Q000523:psychology*; D002637:Chest Pain / Q000503:physiopathology / Q000523:psychology; D003625:Data Collection; D004244:Dizziness / Q000503:physiopathology / Q000523:psychology; D004417:Dyspnea / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D005082:Physical Exertion; D011788:Quality of Life / Q000523:psychology; D012737:Sex Factors; D013315:Stress, Psychological / Q000503:physiopathology*