Broken Heart Syndrome Real and May Be Deadly


“Broken Heart Syndrome.  BHS.  When someone else’s B-S affects your Heart, you get BHS. Other times, grief from the death of a loved one can trigger it.  Symptoms of BHS can mimic a heart attack.  Severe, but reversible.  Your heart may take up to two weeks to recover from BHS.  A reminder that your heart is precious and linked to your overall health and well-being.”  ~Maria Dorfner

BROKEN HEART” SYNDROME: REAL, POTENTIALLY DEADLY BUT RECOVERY QUICK

— Hopkins scientists discover that emotional shock can trigger sudden, reversible heart failure that is not a classic heart attack

Hopkins cardiologist Ilan Wittstein, M.D.*click on image for higher resolution version

Shocking news, such as learning of the unexpected death of a loved one, has been known to cause catastrophic events, such as a heart attack.

Researchers at Johns Hopkins have discovered that sudden emotional stress can also result in severe but reversible heart muscle weakness that mimics a classic heart attack.  Patients with this condition, called stress cardiomyopathy but known colloquially as “broken heart” syndrome, are often misdiagnosed with a massive heart attack when, indeed, they have suffered from a days-long surge in adrenalin (epinephrine) and other stress hormones that temporarily “stun” the heart.

“Our study should help physicians distinguish between stress cardiomyopathy and heart attacks,” says study lead author and cardiologist Ilan Wittstein, M.D., an assistant professor at The Johns Hopkins University School of Medicine and its Heart Institute.  “And it should also reassure patients that they have not had permanent heart damage.”

In the Hopkins study, published in The New England Journal of Medicine, the research team found that some people may respond to sudden, overwhelming emotional stress by releasing large amounts of catecholamines (notably adrenalin and noradrenalin, also called epinephrine and norepinephrine) into the blood stream, along with their breakdown products and small proteins produced by an excited nervous system.  These chemicals can be temporarily toxic to the heart, effectively stunning the muscle and producing symptoms similar to a typical heart attack, including chest pain, fluid in the lungs, shortness of breath and heart failure.

Upon closer examination, though, the researchers determined that cases of stress cardiomyopathy were clinically very different from a typical heart attack.

“After observing several cases of ‘broken heart’ syndrome at Hopkins hospitals – most of them in middle-aged or elderly women – we realized that these patients had clinical features quite different from typical cases of heart attack, and that something very different was happening,” says Wittstein.  “These cases were, initially, difficult to explain because most of the patients were previously healthy and had few risk factors for heart disease.”

For example, examination by angiogram showed no blockages in the arteries supplying the heart.  Blood tests also failed to reveal some typical signs of a heart attack, such as highly elevated levels of cardiac enzymes that are released into the blood stream from damaged heart muscle.  Magnetic resonance imaging (MRI) scans confirmed that none of the stressed patients had suffered irreversible muscle damage.  Of greatest surprise, the team says, was that recovery rates were much faster than typically seen after a heart attack.  Stressed patients showed dramatic improvement in their hearts’ ability to pump within a few days and had complete recovery within two weeks.  In contrast, partial recovery after a heart attack can take weeks or months and, frequently, the heart muscle damage is permanent.

The researchers collected detailed histories and conducted several tests, including blood work, echocardiograms, electrocardiograms, coronary angiograms, MRI scans and heart biopsies, on a total of 19 patients who came to Hopkins between November 1999 and September 2003.  All had signs of an apparent heart attack immediately after some kind of sudden emotional stress, including news of a death, shock from a surprise party, fear of public speaking, armed robbery, a court appearance and a car accident.  Eighteen of the stressed patients were female, between the age of 27 and 87, with a median age of 63.  The results were then compared to seven other patients, all of whom had suffered classic, severe cases of heart attack, called a Killip class III myocardial infarction.

When results from both groups were compared, the researchers found that initial levels of catecholamines in the stress cardiomyopathy patients were two to three times the levels among patients with classic heart attack, and seven to 34 times normal levels.

  • Catecholamine metabolites, such as metanephrine and normetanephrine, were also massively elevated, as were other stress-related proteins, such as neuropeptide Y, brain natriuretic peptide and serotonin.  These results provided added confirmation that the syndrome was stress induced.  Heart biopsies also showed an injury pattern consistent with a high catecholamine state and not heart attack.

A hallmark feature of the syndrome was the heart’s unique contraction pattern as viewed by echocardiogram, or ultrasound.  While the base of the heart’s main pumping chamber, the left ventricle, contracted normally, there was weakened contraction in the middle and upper portions of the muscle.  Other characteristics included a distinctive pattern on electrocardiogram, or EKG.

“How stress hormones act to stun the heart remains unknown, but there are several possible explanations that will be the subject of additional studies,” says study co-investigator and cardiologist Hunter Champion, M.D., Ph.D., an assistant professor at Hopkins and its Heart Institute.  “The chemicals may cause spasm in the coronary arteries, or have a direct toxic effect on the heart muscle, or cause calcium overload that results in temporary dysfunction.”

The researchers also plan to study whether certain patients have a specific genetic vulnerability for developing stress cardiomyopathy, and why it predominantly strikes older women.

While the folklore of “broken heart” syndrome has been around for decades, the prevalence of the condition remains unknown.  According to Wittstein, some reports exist, mainly from Japan, and describe similar syndromes, but no biochemical analyses have previously been performed that link the condition to elevated catecholamine levels.  The researchers contend that while stress cardiomyopathy is not as common as a typical heart attack, it likely occurs more frequently than doctors realize.  They expect its numbers to increase as more physicians learn to recognize the syndrome’s unique clinical features.

Funding for this study, conducted solely at Johns Hopkins, was provided by the Bernard A. and Rebecca S. Bernard Foundation.  Other researchers who took part in this study were Trinity Bivalacqua, M.D., Ph.D.; Jeffrey Rade, M.D.; Katherine Wu, M.D.; Gary Gerstenblith, M.D.; Steven Schulman, M.D.; Kenneth Baughman, M.D.; João Lima, M.D.; and David Thiemann, M.D.

GRIEF AND THE BROKEN HEART:

http://www.freep.com/article/20120110/FEATURES01/201100309/Broken-heart-isn-t-just-fiction

More on Broken Heart Syndrome from MAYO CLINIC

By Mayo Clinic staff


Original Article:  http://www.mayoclinic.com/health/broken-heart-syndrome/DS01135


Definition

Broken heart syndrome is a temporary heart condition brought on by stressful situations, such as the death of a loved one. People with broken heart syndrome may have sudden chest pain or think they’re having a heart attack. These broken heart syndrome symptoms may be brought on by the heart’s reaction to a surge of stress hormones. In broken heart syndrome, a part of your heart temporarily enlarges and doesn’t pump well, while the remainder of the heart functions normally or with even more forceful contractions.

The condition was originally called takotsubo cardiomyopathy. Today, it’s also referred to as stress cardiomyopathy, stress-induced cardiomyopathy or apical ballooning syndrome.

The symptoms of broken heart syndrome are treatable, and the condition usually reverses itself in about a week.

Symptoms

Broken heart syndrome symptoms can mimic a heart attack. Common symptoms include:

  • Chest pain
  • Shortness of breath
  • An irregular heartbeat
  • A generalized weakness

Any long-lasting or persistent chest pain could be a sign of a heart attack, so it’s important to take it seriously and call 911 if you experience chest pain.

When to see a doctor
If you’re having any chest pain, a very rapid or irregular heartbeat, or shortness of breath after a stressful event, call 911 or emergency medical assistance immediately.

Causes

The exact cause of broken heart syndrome is unclear. It’s thought that a surge of stress hormones, such as adrenaline, might temporarily damage the hearts of some people. How these hormones might hurt the heart or whether something else is responsible isn’t completely clear. A temporary constriction of the large or small arteries of the heart may play a role.

Broken heart syndrome is often preceded by an intense physical or emotional event. Some potential triggers of broken heart syndrome are:

  • News of an unexpected death of a loved one
  • A frightening medical diagnosis
  • Domestic abuse
  • Losing a lot of money
  • A surprise party
  • Having to perform publicly
  • Physical stressors, such as an asthma attack, infection, a car accident or major surgery

How is broken heart syndrome different from a heart attack?
Most heart attacks are caused by a complete or near complete blockage of a heart artery. This blockage is due to a blood clot forming at the site of narrowing from fatty buildup (atherosclerosis) in the wall of the artery. In broken heart syndrome, the heart arteries are not blocked, although blood flow in the arteries of the heart may be reduced.

Risk factors

Broken heart syndrome affects women far more often than men. It appears that most people who have broken heart syndrome are women 50 or older.

Complications

In rare cases, broken heart syndrome is fatal. However, most who experience broken heart syndrome quickly recover and don’t have long-lasting effects.

Other complications of broken heart syndrome include:

  • Disruptions in your heartbeat
  • A fast or slow heartbeat
  • Backup of fluid into your lungs (pulmonary edema)

It’s also possible that you may have broken heart syndrome again if you have another stressful event.

Preparing for your appointment

Broken heart syndrome is almost always diagnosed in an emergency or hospital setting, since most people with the condition have symptoms identical to a heart attack.

Call 911 or emergency medical help or have someone drive you to an emergency room if you experience new or unexplained chest pain or pressure that lasts for more than a few moments. Don’t waste any time for fear of embarrassment if it’s not a heart attack. Even if there’s another cause for your chest pain, you need to be seen right away.

Have a family member or friend come with you, if possible. Someone who accompanies you can help soak up all the information provided during your evaluation.

Share this information on the way to the hospital:

  • Any symptoms you’re experiencing, and how long you’ve had them.
  • Your key personal information, including any major stresses, such as the death of a loved one, or recent life changes, such as the loss of a job.
  • Your personal and family medical history, including other health problems that you or your close relatives have had, such as diabetes, high cholesterol or heart disease. It’s also helpful for your doctor to know about any prescription and over-the-counter medications you’re taking.
  • Any recent trauma to your chest that may have caused an internal injury, such as a broken rib or pinched nerve.

Once you’re at the hospital, it’s likely that your medical evaluation will move ahead rapidly. Based on results from an electrocardiogram (ECG) and blood tests, your doctor may be able to quickly determine if you are having a heart attack — or give you another explanation for your symptoms. You’ll probably have a number of questions at this point. If you haven’t received the following information, you may want to ask:

  • What do you think is causing my symptoms?
  • Could my symptoms be due to the sudden unexpected death of my partner, as I’ve never had any symptoms like this before?
  • What kinds of tests do I need?
  • Will I need to stay in the hospital?
  • What treatments do I need right now?
  • What are the risks associated with these treatments?
  • What are the next steps in my diagnosis and treatment?
  • Do I need to follow any restrictions in my diet or exercise routine after returning home?
  • Should I see a specialist after returning home?

Don’t hesitate to ask any additional questions that occur to you during your medical evaluation.

What to expect from the doctor
A doctor who sees you for chest pain may ask:

  • What are your symptoms?
  • When did you first begin experiencing symptoms?
  • Have your symptoms gotten worse over time?
  • Where does your pain seem to start?
  • Does your pain radiate to any other parts of your body?
  • Does your pain momentarily increase with each heartbeat?
  • What words would you use to describe your pain?
  • Are you having any trouble breathing?
  • Do your symptoms include nausea or vomiting?
  • Do your symptoms include dizziness or lightheadedness?
  • Does exercise or physical exertion make your symptoms worse?
  • Does anything else seem to make your pain worse?
  • Does anything seem to make your pain better?
  • Are you aware of any history of heart problems in your family?
  • Are you being treated or have you recently been treated for any other health conditions?
  • Have you ever been diagnosed with gastroesophageal reflux disease (GERD)?
  • What medications are you currently taking, including vitamins and supplements?
  • Do you or did you smoke? How much?
  • Do you use alcohol or caffeine? How much?

Tests and diagnosis

If your doctor suspects you have broken heart syndrome, he or she will use these exams and tests to make a diagnosis:

  • Personal history and physical exam. In addition to a standard physical exam, your doctor will want to know about your medical history, especially whether you’ve ever had heart disease symptoms. People who have broken heart syndrome typically don’t have any heart disease symptoms before they’re diagnosed with broken heart syndrome. Also, your doctor will want to know if you’ve experienced any major stresses recently, such as the death of a loved one.
  • Electrocardiogram (ECG). In this noninvasive test, a technician will place wires on your chest that record the electrical impulses that make your heart beat. An ECG records these electrical signals and can help your doctor detect irregularities in your heart’s rhythm and structure.
  • Chest X-ray. Your doctor will likely order a chest X-ray of your chest to see if your heart is enlarged or has the shape that’s typical of broken heart syndrome, or to see if there are any problems in your lungs that could be causing your symptoms.
  • Echocardiogram. Your doctor may also order an echocardiogram to see if your heart is enlarged or has an abnormal shape, a sign of broken heart syndrome. This noninvasive exam, which includes an ultrasound of your chest, shows detailed images of your heart’s structure and function. Ultrasound waves are transmitted, and their echoes are recorded with a device called a transducer that’s held outside your body. A computer uses the information from the transducer to create moving images on a video monitor.
  • Blood tests. Most people who have broken heart syndrome have an increased amount of certain enzymes in their blood. Your doctor may order blood tests to check for these enzymes to help diagnose broken heart syndrome.

Treatments and drugs

There are no standard treatment guidelines for treating broken heart syndrome. Treatment is similar to treatment for a heart attack until the diagnosis is clear. Most people stay in the hospital while they recover.

Once it’s clear that broken heart syndrome is the cause of your symptoms, your doctor will likely prescribe heart medications for you to take while you’re in the hospital, such as angiotensin-converting enzyme (ACE) inhibitors, beta blockers or diuretics. These medications help reduce the workload on your heart while you recover and may help prevent further attacks. Many patients make a full recovery within one to two months. Ask your doctor how long you will need to continue taking these medications once you recover.

Procedures that are often used to treat a heart attack, such as balloon angioplasty and stent placement, or even surgery, are not helpful in treating broken heart syndrome. These procedures treat blocked arteries, which are not the cause of broken heart syndrome. However, coronary angiography is often used to diagnose exactly what’s the cause of the chest pain.

Prevention

There’s a chance that broken heart syndrome can happen again after a first episode. There’s no proven therapy to prevent additional episodes; however, many doctors recommend long-term treatment with beta blockers or similar medications that block the potentially damaging effects of stress hormones on the heart. Managing stress in your life is also important.

DS01135Feb. 10, 2011

© 1998-2012 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. “Mayo,” “Mayo Clinic,” “MayoClinic.com,” “EmbodyHealth,” “Enhance your life,” and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.

NEW YORK TIMES LINK:

http://well.blogs.nytimes.com/2012/01/09/really-the-claim-grief-can-cause-a-heart-attack/?partner=rss&emc=rss

PATRIOT LEDGER:

http://www.patriotledger.com/news/x2079020136/Broken-heart-syndrome-after-loss-of-loved-one

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