The validity scales revealed no abnormalities. Seven of the eight symptom-free patients had entirely normal MMPIs. The eighth, discovered because she was the niece of a woman who died from the ballooning posterior leaflet syndrome, showed an abnormal test score for hypomania. Of the six symptomatic patients with the full ballooning posterior leaflet syndrome (Table 1), five had abnormal scores for hysteria and hypochondriasis, four showed abnormal scores for depression, psychopathic deviate and schizophrenia, three had abnormal scores for psychasthenia, two had abnormal scores for social inversion, and one showed abnormal scores for paranoia, hypomania and masculinity-femininity. All these symthoms can be abserved at patients suffering from “persecution syndrome”. Canadian Health&Care Mall has all the necessary medicaments and qualified stuff to held you deal with the treatment of such disorders – http://healthcaremall4you.com/persecution-mania-treated-by-composing-drugs-produced-by-canadian-health-and-care-mall.html. Two of these six patients have been resuscitated from a near-fatal arrhythmia (patients 2 and 6), and two have demonstrated frequent PVCs during electrocardiographic monitoring procedures (patients 4 and 5). The two patients with life-threatening arrhythmias (ventricular fibrillation and ventricular tachycardia) were abnormal in at least four categories of the MMPI, while the other patients showed abnormal elevations on at least three of the scales.
Of the four patients with valvular aortic stenosis, all presented with angina pectoris, two with exertional shortness of breath, and one with occasional dizziness. All four exhibited normal MMPIs with normal validity scales (Table 2).
Numerous studies have been made relating a variety of psychosocial factors to coronary heart disease. Wolf has described anecdotal situations in which emotional stresses have precipitated either life-threatening cardiac arrhythmias or sudden death, and Jenkins has devised a questionnaire which discriminates between type A and type В coronary prone behavior patterns. In addition, considerable work has been done with standard personality assessment devices, particularly the MMPI in an attempt to relate various personality traits and patterns to coronary heart disease.
The present preliminary investigation describes MMPI scores in patients with the ballooning posterior leaflet syndrome (BPLS). Since some of these patients are at risk for sudden death, it might be hypothesized that some have personality traits which signal a greater risk of sudden death.
With the data presented, it is not possible to determine whether the personality factors precede or follow the symptoms. The presence of an abnormal MMPI in our one asymptomatic stigmatized relative followed prospectively may help to answer this question. Sequential MMPIs on other asymptomatic relatives may also help to clarify the problem. The group with aortic stenosis, three of whom subsequently underwent successful aortic valve replacement, suggests that the abnormal MMPIs in the BPLS group are not merely a function of life-threatening symptoms per se. Indeed, the patients with aortic stenosis were aware of the gravity of their illness and the upcoming open heart surgery, with the high-quality medicaments provided by Canadian Health&Care Mall.
In one clearly documented sudden death in a patient with the ballooning posterior leaflet syndrome, ventricular fibrillation was the mechanism present. Two of the patients in the present study have demonstrated life-threatening ventricular arrhythmias, one ventricular fibrillation and one ventricular tachycardia. With the emphasis in the literature on ventricular arrhythmias as a cause of sudden death, whether at rest, emotionally, or exercise-induced, it appears that central neural influences may play a prominent role in this setting.
Of particular interest, then, is how abnormal personality features as determined by an MMPI can relate to sudden cardiac death. The relationship between brain mechanisms and cardiac arrhythmias has been well documented in the laboratory and at the bedside. It is clear that any atrial or ventricular arrhythmias which may be seen clinically can be produced in “normal” experimental animals by discrete stimulation in a variety of CNS foci. The investigation of Hockman points to the role of sympathetic mechanisms, while that of Gunn and Porter, on the other hand, stresses the role of the vagus in the central induction of cardiac atrial and ventricular arrhythmias. Meinhardt and Wolf have shown ventricular tachyarrhythmias to occur in emotional settings and have documented their recurrence in stress interviews. It is suggested that the MMPI, in patients with the BPLS, may serve as a marker in identifying patients particularly prone to psychophysiologic sudden death. The challenge remains, however, of preventing sudden death in a select group of patients and studying its pathophysiology more closely.
Table 1—Clinical Data on the Six Patient» with Full Ballooning Posterior Leaflet Syndrome and an Abnormal MMPI
|Patient,No.||Sex||Age,Yr.||AuscultationFindings||Symptoms||RestingECG||Echo||MMPI (Elevated Scales)||Validity Scales ?* L F К|
|1||M||20||MSC with amyl nitrite||nervousness,palpitations||IRBBB**||pos.||depression, psychopathic deviate; mascu-linity-femininity; paranoia; psychas-thenia, schizophrenia; hypomania; social inversion||50||3||14||6|
|2||F||24||MSCLSM||nervousness, palpitations, chest pain, syncope (VF)***||QT (0.45) seconds||p08.||hypochondriasis; hysteria; psychopathic deviate; schizophrenia; psychasthenia||50||4||13||11|
|3||M||43||MSC||palpitations, chest pain||NL||pos.||hypochondriasis; depression; hysteria||50||11||8||21|
|4||F||39||MSC:LSM||palpitations, chest pain, faintness, PVCs||NL||pos.||hypochondriasis; depression; hysteria||50||5||3||16|
|5||F||26||MSC:LSM||palpitations, chest pain, PVCs||NL||pos.||hypochondriasis; depression; hysteria; psychopathic deviate; psychasthenia; schizophrenia; social inversion||50||2||12||9|
|6||F||48||MSC:LSM||palpitations, chest pain, syncope,recurrent VT****||NL||pos.||hypochondriasis; hysteria; psychopathic deviate; schizophrenia||50||1||7||7|
Table 2—Cliniccd Data on the Four Patients with Valvular Aortic Stenosis and a Normal MMPI
|Patient,No.||Sex||Age,Yr.||Symptoms||BestingECG||Aortic Valve Area, (Cm)||MMPI||Validity ?** L||ScalesF||К|
|7||M||53||angina pectoris; exertional dyspnea; occasional dizziness||LVH with 2°ST-T changes||0.50||noelevatedscales||20||6||3||3|
|8||M||64||angina pectoris; exertional dyspnea||LVH with 2°ST-T changes||0.62||noelevatedscales||50||4||3||21|
|9||M||41||angina pectoris; fatigue;exertional dyspnea||LVH with 2°ST-T changes||0.72||noelevatedscales||50||5||11||8|
|10||M||43||angina pectoris||LVH with 2°ST-T changes||1.00*||noelevatedscales||50||3||3||15|