Identifying and Treating Broken Heart Syndrome
Stress affects our bodies. For some patients, this will manifest as chest pain, dyspnea or other symptoms that are cardiac in nature. In some cases, this may simply be an anxiety attack. A more significant or serious demonstration of these types of symptoms could be due to a disease called takotsubo cardiomyopathy.
Takotsubo cardiomyopathy, also called stress cardiomyopathy, is commonly referred to as broken heart syndrome. It is generally a temporary heart condition that is frequently brought on by stressful situations. In one study, emotions like fear, grief, anger or anxiety appear to be the trigger in about 28% of cases. These emotions may result from a variety of situations, including:
- Death of a loved one
- A frightening medical diagnosis
- Domestic abuse
- Losing or winning a lot of money
- Strong emotional arguments
- Loss of a job
- Fear of performing publicly
- Physical stressors (e.g., asthma attack, car crash, or major surgery)
- Surprise parties
Typical symptoms associated with broken heart syndrome are chest pain, shortness of breath, dizziness, nausea and vomiting, diaphoresis, weakness, and palpitations. More serious presentations can include hypotension, congestive heart failure, and even shock. In some patients, elevated levels of troponin and an initial 12-lead ECG suggestive of acute myocardial infarction were noted.
While these symptoms physically and physiologically mimic an acute myocardial infarction (AMI), broken heart syndrome does not cause any blockage of the coronary arteries. Instead, it uses adrenaline and other hormones to temporarily “stun” the heart muscle. The precise way adrenaline affects the heart isn’t completely known but it is believed that it constricts the coronary arteries resulting in a temporary restriction of oxygenated blood flow to the myocardium. Adrenaline may also cause the influx of a large amount of calcium into myocardial cells. This binds them and makes them temporarily dysfunctional. This infusion of calcium misshapes myocardial cells and causes hypokinesia and slowed relaxation. So, while a patient with broken heart syndrome can have myocardial weakness, in many cases, the heart recovers completely within a few weeks with no permanent or long-term damage.
Women are eight or nine times more likely to experience broken heart syndrome than men, and most patients are at least 55 years old. Younger men and women can have broken heart syndrome, but one study found that most patients (up to 90%) are post-menopausal women. This high percentage suggests that estrogen may be a protective mechanism in younger women. This hypothesis concludes that after menopause, when estrogen levels drop, women are no longer protected. At least one study proposed cannabis use as a potential risk factor for broken heart syndrome. This study suggests that endocannabinoids have cardiovascular effects such as reduced contractility and have the potential to cause brady and tachy-arrhythmias impairing cardiac function.
Broken heart syndrome is relatively rare and occurs in about 0.2% of all hospitalizations in the United States. About 2% of patients who, based on initial presentation and examination, appear to be having a heart attack are actually experiencing broken heart syndrome. These patients are usually treated for an AMI based on their symptoms with typical diagnostic tools including 12-Lead ECG, cardiac enzymes panels and cardiac catheterization. Once the diagnosis of broken heart syndrome is made, therapy is normally supportive care until the symptoms resolve and cardiac function returns to normal. Up to 4% of patients who experience broken heart syndrome have a recurrent episode in a year. That number jumps to 20% in 10 years. Since the patient suffers no permanent myocardial damage, long-term prognosis for these patients is very good.
There is no proven therapy to prevent broken heart syndrome. There are indications that improving both physical and psychological health, as well as learning relaxation, problem-solving, and stress management techniques can help. Physical exercise can also help reduce stress levels.
In rare instances takotsubo cardiomyopathy can be fatal or may exacerbate existing conditions that can be fatal. One example is the death of actress Debbie Reynolds. Reynolds’ daughter, Star Wars star Carrie Fisher, died suddenly on Dec. 27, 2016. Twenty-four hours later, her mother, Debbie Reynolds, suffered a fatal stroke. Broken heart syndrome has also been speculated as the cause of death of Johnny Cash, who died within months of the passing of his wife June Carter Cash.
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