Abstract
Aim. The purpose of this study was to compare the effect of “acceptance and commitment therapy” and “stress inoculation training” on stress symptoms in people with broken heart syndrome.
Background. Stress is considered to be the main driving force of broken heart syndrome, while broken heart syndrome also causes stress. It seems that training the patient for correct use of coping strategies during stressful events is effective in preventing recurrence.
Method. In this quasi-experimental pre-test post-test design with control group, 62 people referred to Tohid Hospital in Sanandaj during 2016-2017 and had been diagnosed as with broken heart syndrome were considered as accessible population, out of which 30 patients were recruited by convenience sampling method and randomly assigned to three groups. Research tool was the stress syndrome scales in Persian language.  For intervention groups, the acceptance and commitment therapy and stress inoculation training interventions was conducted in weekly sessions. The questionnaire were filled out before intervention, after intervention and one month after intervention by the three groups. Data were analyzed in SPSS using descriptive and inferential statistics.
Findings. Compared with control group, acceptance and commitment therapy (F=87.65, P≤0.0001) and stress inoculation training (F=61.18, P≤0.0001) were effective in reducing stress symptoms and the effect of the acceptance and commitment therapy was remarkable. In addition to the stability of the effect of both interventions one month after intervention, the effect of acceptance and commitment therapy was found to be superior to stress inoculation training.
Conclusion. Both modalities; especially acceptance and commitment therapy, can be used as effective methods with wide applicability in preventing and reducing symptoms of stress and improving the status of people with broken heart syndrome.

Abstract
Aim. The aim of this review was to investigate the role of Catecholamines in the pathogenesis of Takotsubo cardiomyopathy and related nursing care.
Background. Takotsubo cardiomyopathy is an acute syndrome characterized by acute reversible systolic dysfunction of the apical and middle segments of the left ventricle in the absence of significant coronary artery occlusion. It is believed that emotional and physical stressors are the main drivers for the disease. Despite many years of efforts to better understand this disorder, current knowledge is limited, but several authors have agreed on the relationship between Catecholamines and the development of this syndrome.
Method. This study was carried out by searching the databases and search engines (PubMed, Google Scholar, and Web of Science) to find full text articles published between 2014-2018 using the keywords "Broken heart syndrome", "Apical ballooning syndrome", "Takotsubo cardiomyopathy", "Stress-induced cardiomyopathy", “Catecholamines”, “Nursing” and “Nursing care”. Of 392 articles, 21 were included in the study.
Findings. Among the various hypotheses, Catecholamine-induced microvascular dysfunction is currently the most accepted hypothesis. Stressful stimuli can increase the activity of the Hypothalamus-Pituitary- Adrenal axis and release Catecholamine. If Catecholamines are the leading cause of Takotsubo cardiomyopathy, it is quite possible that prescribing exogenous Catecholamines cause this condition.
Conclusion. Although many studies have attributed some of the Catecholamine toxicity to the pathophysiology of Takotsubo cardiomyopathy, due to the potential impact on current treatment strategies, further study is required. Due to cardiovascular side effects, the use of Catecholamines for therapeutic purposes requires more evidence. Regarding the similarity of the symptoms of this syndrome with myocardial ischemia, nursing care in this type of cardiomyopathy is very important.