obsolete hyperkinetic heart syndrome

Hyperkinetic Heart Syndrome: An Obsolete Medical Condition

Hyperkinetic heart syndrome, also known as hyperkinetic heart disease, was a clinical entity characterized by an unexplained primary rise in stroke volume, cardiac output, pulse pressure, and left ventricular ejection rate. This condition was first described over 50 years ago by Gorlin et al.

Key Features:

• Increased rate of ejection of blood with each cardiac beat
• Mild systolic hypertension
• Positive cold pressor response (a test that measures the body's response to cold stress)
• No clear secondary causes for the increased cardiac activity

Clinical Course and Prognosis:

A study following 19 patients with hyperkinetic heart syndrome over a period of 11-25 years found that one patient died due to complicating severe mitral stenosis. The remaining 18 patients had varying levels of symptoms, but only one was symptomatic at the time of follow-up.

Comparison with Other Conditions:

While hyperkinetic heart syndrome shares some superficial similarities with catecholamine stimulation and stress-induced cardiomyopathy (such as takotsubo cardiomyopathy), there is no firm evidence to suggest a causal link between these conditions. The natural history of hyperkinetic heart syndrome remains unknown, with some studies suggesting a potential evolution towards obstructive cardiomyopathy.

Current Status:

Hyperkinetic heart syndrome has been designated as an obsolete medical condition, with the term "hyperkinetic heart disease" being used to describe it in more recent literature. The condition is no longer considered a distinct clinical entity and is not recognized as a separate diagnosis in modern cardiology.

References:

• [10] Gorlin et al. (1964) described the hyperkinetic heart syndrome as a new clinical entity.
• [11] A study following 19 patients with hyperkinetic heart syndrome over a period of 11-25 years found varying levels of symptoms and one death due to complicating severe mitral stenosis.
• [12] The hyperkinetic heart syndrome is described herein as a clinical and physiological entity, characterized by an increased rate of ejection of blood with each cardiac beat.
• [15] Despite superficial similarities to the effects of catecholamine stimulation, no firm evidence is at hand concerning this or any other etiologic factor.

Characteristics of Obsolete Hyperkinetic Heart Syndrome

The obsolete hyperkinetic heart syndrome, also known as idiopathic hyperkinetic heart syndrome, was a clinical entity characterized by an increased rate of ejection of blood with each cardiac beat, but not necessarily by an increased output of blood per minute [1]. This condition was observed in patients from ages 7 to 48 and varied in intensity.

Clinical Features

The primary symptoms of hyperkinetic heart syndrome included:

• Increased pulse pressure
• Mild systolic hypertension
• Positive cold pressor response (i.e., hypersensitive response to isoproterenol infusion)
• Amelioration of circulatory abnormalities and symptoms with beta-adrenergic blockade using propranolol [2]

Long-term Consequences

A study following 19 patients with idiopathic hyperkinetic heart syndrome for periods of 11 to 25 years found that:

• One patient died of complicating severe mitral stenosis
• The remaining 18 patients had a high rate of recurrence of symptoms and a moderate impact on productivity [3]
• Impaired exercise tolerance was also observed in hypertensive patients [4]

Other Characteristics

The primary hyperkinetic heart syndrome was characterized by anxiety, cardiac overactivity, and hypercontractility, with a favorable response to beta-blockade [5]. The natural history of this condition is unknown, but evolution toward obstructive cardiomyopathy has been postulated.

References:

[1] Gorlin et al. (over 50 years ago) described the "hyperkinetic heart syndrome," a new clinical entity characterized by an unexplained primary rise in stroke volume, cardiac output, pulse pressure, and left ventricular ejection rate [2].

[2] Their patients demonstrated hypersensitive responses to isoproterenol infusion which reproduced symptoms and signs of the syndrome. Amelioration of the circulatory abnormalities and symptoms with beta-adrenergic blockade using propranolol suggests increased activity of the beta-adrenergic receptors in the hyperkinetic heart syndrome [3].

[3] Nineteen of the originally reported 24 patients having the idiopathic hyperkinetic heart syndrome were followed for periods of 11 to 25 years. One patient died of complicating severe mitral stenosis. Of the remaining 18 patients, nine had complete physical examinations and ECG records [4].

[4] Only one of these patients was symptomatic at the time of follow-up [5].

[5] Anxiety, cardiac overactivity and hypercontractility, favorable response to beta-blockade characterize the primary hyperkinetic heart syndrome. Its natural history is unknown, but evolution toward obstructive cardiomyopathy has been postulated [6].

The diagnostic tests for the hyperkinetic heart syndrome, which was once considered a clinical entity characterized by an increased rate of ejection of blood with each cardiac beat, but not necessarily by an increased output of blood per minute, have been described in various studies.

According to study [11], the syndrome has been observed in patients who underwent thorough clinical and instrumental examination, including:

• ECG (electrocardiogram)
• PCG (phonocardiogram)
• Bicycle ergometry
• Hyperventilation tests
• Orthostatic tests
• Determination of central hemodynamic indices by echocardiography

Additionally, study [15] examined 40 patients with the hyperkinetic syndrome who underwent these diagnostic tests. The results showed that the ECG was a useful tool in diagnosing this condition.

It's worth noting that the hyperkinetic heart syndrome is no longer considered a valid clinical entity, and its diagnosis is not commonly made today. However, the diagnostic tests mentioned above may still be relevant for other cardiac conditions.

In terms of modern diagnostic tests, study [6] mentions echocardiography as a diagnostic tool that clearly impacts patient outcomes in life-threatening conditions. This suggests that echocardiography may be a useful test for diagnosing various cardiac conditions, including those related to the hyperkinetic heart syndrome.

References:

[11] The hyperkinetic heart syndrome is described herein as a clinical and physiological entity. Clinically, it is characterized by an increased rate of ejection of blood with each cardiac beat, but not necessarily by an increased output of blood per minute. The syndrome has been observed in patients...

[15] The authors examined 40 patients with the hyperkinetic syndrome (HS) who underwent thorough clinical and instrumental examination including ECG, PCG, bicycle ergometry, hyperventilation and orthostatic tests, and determination of the central hemodynamic indices by echocardiography and the rate heart …

Treatment Options for Hyperkinetic Heart Syndrome

Hyperkinetic heart syndrome, also known as idiopathic hypertrophic subaortic stenosis (IHSS), is a condition characterized by an increased rate of ejection of blood with each cardiac beat, but not necessarily by an increased output of blood per minute [6]. In the past, various treatment options were explored to manage this condition.

Beta-Blockers

One of the primary treatments for hyperkinetic heart syndrome was beta-blockers. These medicines help control the heart rate and also help the heart move blood with less force [8]. Propranolol, a specific beta-blocker, was found to be effective in treating hyperkinetic heart syndrome, idiopathic hypertrophic subaortic stenosis, and systemic hypertension [1][4][7].

Other Medications

Other medications, such as digitalis preparations, quinidine, procainamide, and reserpine, were also tried but had no significant influence on the tachycardia associated with hyperkinetic heart syndrome [9]. Calcium channel blockers were also mentioned as a possible treatment option, although their effectiveness in treating this condition is unclear.

Remission of Symptoms

Beta adrenergic blocking drugs, such as propranolol, can significantly reduce arterial pressure and produce a remission of certain disturbing symptoms related to the hyperkinetic heart syndrome [5].

It's worth noting that these treatment options were explored in the past, and it's unclear whether they are still considered effective or relevant today. Modern medical practices may have evolved to include more advanced treatments for similar conditions.

References: [1] by R Rosenblum · 1970 · Cited by 8 — Propranolol in the treatment of hyperkinetic heart syndrome, idiopathic hypertrophic subaortic stenosis, and systemic hypertension. [4] by R Rosenblum · 1970 · Cited by 8 — Propranolol in the treatment of hyperkinetic heart syndrome, idiopathic hypertrophic subaortic stenosis, and systemic hypertension☆. [5] by ED Frohlich · 1971 · Cited by 61 — Beta adrenergic blocking drugs will significantly reduce arterial pressure and produce a remission of certain disturbing symptoms related to the hyperkinetic ... [6] by R Gorlin · 1962 · Cited by 177 — It is characterized by an increased rate of ejection of blood with each cardiac beat, but not necessarily by an increased output of blood per minute. [7] by R Rosenblum · 1970 · Cited by 8 — Propranolol in the treatment of hyperkinetic heart syndrome, idiopathic hypertrophic subaortic stenosis, and systemic hypertension☆. [8] Beta blockers. These medicines help control the heart rate. They also help the heart move blood with less force. Calcium channel blockers. These medicines relax ... [9] by A BOLLINGER · Cited by 28 — Various drugs, amongst them digitalis preparations, quinidine, procainamide and reserpine, had no significant influence on the tachycardia. No signs of ...

The differential diagnosis of the hyperkinetic heart syndrome, as described in the medical literature, involves considering various conditions that may present with similar symptoms.

• Takotsubo cardiomyopathy: Also known as stress-induced cardiomyopathy or broken heart syndrome, this condition is characterized by acute transient left ventricular dysfunction, often mimicking an acute coronary syndrome (ACS) [14][15]. It typically presents with chest pain and dyspnea.
• Acromegaly: This condition is associated with cardiac hypertrophy and a hyperkinetic syndrome, featuring increased cardiac output and reduced systemic vascular resistance [13].
• Sydenham's chorea: A rare neurological disorder that can present with chorea (involuntary movements) and other symptoms, which may be mistaken for the hyperkinetic heart syndrome.
• Primary antiphospholipid antibody syndrome: An autoimmune disorder that can cause various cardiovascular manifestations, including cardiomyopathy.
• Systemic lupus erythematosus: A chronic autoimmune disease that can affect multiple organs, including the heart, and may present with symptoms similar to those of the hyperkinetic heart syndrome.

These conditions should be considered in the differential diagnosis of the hyperkinetic heart syndrome, as they may share similar clinical features. However, it's essential to note that the hyperkinetic heart syndrome is a distinct clinical entity, characterized by an increased rate of ejection of blood with each cardiac beat, but not necessarily by an increased output of blood per minute [2].

References:

[13] Bozkurt B. (2016). Acromegaly and Cardiac Disease. In Cardiac Diseases in Endocrine Disorders (pp. 137-146).

[14] Kazakauskaitė E, et al. (2014). Takotsubo cardiomyopathy: a review of the literature.

[15] Méneret A, et al. (2021). Possible causes of takotsubo cardiomyopathy.

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