"Broken-heart" syndrome

“Broken-heart” syndrome is a temporary heart condition that an individual may interpret as a heart attack. It is usually triggered by stress or emotions, but may also be brought on by surgery or serious illness. “Broken-heart” syndrome is also known as stress cardiomyopathy, takotsubo cardiomyopathy, or apical ballooning syndrome. It affects only one part of the heart, a weakening of the left ventricle, and interferes with the organ’s normal pumping function. The condition is rarely seen in men.

Stress cardiomyopathy usually lasts a few days to several weeks. Practitioners have various options to treat the symptoms.

Background

Cardiomyopathy was first described in Japan in 1990. It was given the name takotsubo cardiomyopathy due to the most common form, which is a ballooning of the lower area of the left ventricle. The ventricle looks like a tako-tsubo, a Japanese fishing pot used to trap octopuses, during contraction. A decade later, Western researchers were reporting that this left ventricle dysfunction was seen in patients experiencing emotional stress. However, most research on the topic that was being conducted in Japan was not published in Western journals prior to the early twenty-first century. As of 2005, most Western physicians referred to the condition as stress cardiomyopathy.

Researchers settled on some diagnostic criteria for the condition in 2008. Stress cardiomyopathy is characterized by an absence of obstructive coronary disease and no acute release of plaque, which is made of substances including calcium, cholesterol, and fat; abnormal atrial function such as wall motion in the lower ventrical mid-segments; specific electrocardiographic abnormalities; and the absence of pheochromocytoma (adrenal gland tumor) and myocarditis (inflammation of the heart muscle).

Overview

More than 90 percent of reported cases of stress cardiomyopathy are in post-menopausal women fifty-eight to seventy-five years of age. Up to 5 percent of women who are evaluated for possible heart attack probably have stress cardiomyopathy. Most of those with the disorder do not have long-term heart damage after they recover.

Patients with stress cardiomyopathy typically experience chest pain and shortness of breath after a significant emotional or physical stress. The symptoms are the same as those of a heart attack. The results of an electrocardiogram appear to indicate a heart attack as well. However, diagnostic tests do not reveal obstruction of the coronary artery (the most common cause of a heart attack), and the left ventricle moves abnormally, often ballooning outward. These differences indicate the patient is experiencing stress cardiomyopathy rather than a heart attack. The body releases cardiobiomarkers into the blood when the heart is damaged, but following a heart attack, they rise more slowly and peak higher than seen in a person experiencing stress cardiomyopathy.

Typical stressors that trigger stress cardiomyopathy include the sudden death of a spouse or other loved one, an accident, or a natural disaster. Some examples include an asthma attack, a serious illness, a sudden drop in blood pressure, domestic violence, an intense fear, or a sudden surprise, even a seemingly happy event such as a surprise party. In 2011, more than twenty people experienced stress cardiomyopathy in Christchurch, New Zealand, after an earthquake that killed 185 people.

Researchers continue to study the reason stress cardiomyopathy occurs. Many experts believe it is caused by a sudden flood of stress hormones, such as adrenaline, that stuns the heart. This could cause changes in the muscle cells of the heart, coronary blood vessels, or both, which interfere with the contraction of the left ventricle.

Treatment of stress cardiomyopathy is tailored to the individual and the situation. Some considerations are the patient’s blood pressure and if tests reveal fluid is backing up into the lungs. Treatment may be similar to that of a heart-attack patient; for example, ACE inhibitors, beta blockers, and diuretics or water pills may be administered. Patients with plaque buildup in the arteries may be given aspirin. Physicians may prescribe beta blockers or alpha and beta blockers indefinitely to reduce the effects of stress hormones and prevent future episodes of stress cardiomyopathy. Practitioners may also address stress factors in the patient’s life that could be triggers for the disorder.

Stress has a profound impact on health. Stress causes the body to release adrenaline. This hormone increases respiration and heart rate, causing blood pressure to rise. It also releases cortisol, the primary stress hormone that puts more sugar in the bloodstream for energy and suppresses systems that are not immediately needed, such as the growth process, the digestive and reproductive systems, and the immune system. The body is reacting to a stressor with a fight-or-flight response, preparing for action to confront or escape danger. This response is rooted in human prehistory, when threats included predators and other humans alike. After the danger is past, hormone levels return to normal and the body resumes its regular functions. In modern times, however, threats are rarely so confrontational. Stressors are often long-running concerns, such as chronic illness, financial worries, or interpersonal conflicts. Chronic stress keeps the body constantly prepared for battle, which wears it out. This stress can result in headaches, stomach pain, ulcers, and other symptoms. Suppression of the immune system can wreak havon on one’s health, leaving an individual open to many illnesses and infections.

Individuals prone to stress-related illnesses such as stress cardiomyopathy may work with therapists to develop coping skills. Treatments may include psychosocial therapies, lifestyle changes such as exercise, and relaxation techniques such as meditation.

Patient outlook is generally good. Most patients recover fully within two months. However, about 20 percent of patients experience heart failure. Death is rare. Complications are also rare, but may include abnormal heart rhythms, blood flow obstruction from the left ventricle, or ventricle wall rupture.

A well-known example of apparent stress cardiomyopathy that led to death occurred in 2016 after Star Wars actress Carrie Fisher died. The following day, her mother, actress Debbie Reynolds, died unexpectedly. Their family concluded that Reynolds died of a broken heart due to grief over her loss.

Bibliography

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“Is Broken Heart Syndrome Real?” American Heart Association, www.heart.org/en/health-topics/cardiomyopathy/what-is-cardiomyopathy-in-adults/is-broken-heart-syndrome-real. Accessed 10 Mar. 2020.

Mayo Clinic Staff. “Broken Heart Syndrome.” Mayo Clinic, 2019, www.mayoclinic.org/diseases-conditions/broken-heart-syndrome/symptoms-causes/syc-20354617. Accessed 10 Mar. 2020.

Mayo Clinic Staff. “Chronic Stress Puts Your Heart at Risk.” Mayo Clinic, 19 Mar. 2019, www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037. Accessed 10 Mar. 2020.

Reeder, Guy S., and Abhiram Prasad. “Clinical Manifestations and Diagnosis of Stress (Takotsubo) Cardiomyopathy.” UpToDate, 19 June 2019, www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-stress-takotsubo-cardiomyopathy. Accessed 10 Mar. 2020.

“Yes, You Can Die of a Broken Heart. Here’s How.” ABC News Australia, 7 Mar. 2018, www.abc.net.au/news/2018-03-08/heartbreak-syndrome-and-takotsubo-are-real-for-heart-disease/9523662. Accessed 10 Mar. 2020.

“Stress and Heart Health.” American Heart Association, 2014, www.heart.org/en/healthy-living/healthy-lifestyle/stress-management/stress-and-heart-health. Accessed 10 Mar. 2020.

“Takotsubo Cardiomyopathy (Broken-Heart Syndrome).” Harvard Health Publishing, 29 Jan. 2020, www.health.harvard.edu/heart-health/takotsubo-cardiomyopathy-broken-heart-syndrome. Accessed 10 Mar. 2020.