Associations between Primary Hyperhidrosis and Psychiatric Conditions: A Matched Case-Control Study of 8,508 Patients.

Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic, non-traumatic, and non-iatrogenic separation of the coronary arterial wall by intramural hemorrhage, creating a false lumen that compresses the true lumen and causes myocardial ischemia. SCAD accounts for 1–4% of all acute coronary syndrome (ACS) presentations and is the leading cause of pregnancy-associated myocardial infarction, with over 90% of affected patients being women [,]. The mean age at presentation is 44–53 years, with a predominance in premenopausal women, though cases across all age groups have been reported []. Emotional stressors precede approximately 25% of SCAD events, while physical stressors (isometric exercise, Valsalva maneuvers, intense physical activity) account for an additional 30%, with no identifiable trigger in the remainder []. Takotsubo syndrome (TTS) is a transient form of acute myocardial dysfunction characterized by regional wall motion abnormalities that extend beyond a single coronary territory, typically in the setting of emotional or physical stress. TTS represents 1–2% of patients presenting with suspected ACS or ST-elevation myocardial infarction, with over 90% of patients being postmenopausal women (mean age: 65 years), though significant overlap in age distribution with SCAD exists [,]. Emotional or physical triggers are identified in approximately 65–70% of TTS cases, while no trigger is identified in 30–35% []. Both conditions typically present with acute chest pain mimicking ST-elevation or non-ST-elevation myocardial infarction, often prompting emergent cardiac catheterization. In SCAD, patients may present with chest pain (96%), ST-elevation (26–49%), troponin elevation (nearly universal), and occasionally with cardiogenic shock or ventricular arrhythmias, particularly in cases involving proximal or multivessel dissection [,]. In TTS, the most common presenting symptoms are chest pain (75%) and dyspnea (47%), with ST-elevation in approximately 44% of cases; hemodynamic complications including acute heart failure, left ventricular outflow tract obstruction, cardiogenic shock, and ventricular arrhythmias occur in up to 21.8% of patients during hospitalization [,].