Broken heart syndrome, which is also called Takotsubo cardiomyopathy or stress cardiomyopathy, refers to the weakening of heart muscle that is triggered by severe emotional or physical stress. Though broken heart syndrome does mimic acute coronary syndromes such as angina or a heart attack, it is unlikely to be life-threatening or fatal.
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Takotsubo cardiomyopathy was first described in Japan in 1991. In Japanese, Tako-tsubo translates to ‘fishing pot for trapping octopus’. In case of people affected by this condition, the shape of the left ventricle during systole is similar to that of the fishing pot that is used for trapping octopus, hence the name.
Takotsubo cardiomyopathy is precipitated by severe emotional stress that might be brought upon by the death of a loved one, rejection, or suffering triggered by failed relationships. It has been recently recognized in the United States. According to a study conducted in 2007 (Akashi et al.), Takotsubo cardiomyopathy might account for about 1% of the cases of acute myocardial infarctions (heart attack). Another study (Bybee et al.) suggests that this syndrome accounts for 1.5% and 2.2% of the patients presenting with Q-wave and ST-segment elevation acute coronary syndrome, respectively. More often than not, this condition affects menopausal women who are being evaluated for myocardial infarction (STEMI) or unstable angina. Statistics reveal that this condition mostly affects women in the age group of 58 to 75 years. It is believed that ventricular dysfunction might be associated with decreased estrogen levels in women belonging to this age group. Though the symptoms of broken heart syndrome are similar to ones in angina, it is transient and not as grave as a heart attack.
Also known as stress cardiomyopathy for obvious reasons, broken heart syndrome can easily be mistaken for a myocardial infarction. However, a heart attack occurs in the event of damage or death of heart tissue, which in turn occurs due to obstruction in the supply of oxygenated, nutrient-rich blood to the heart muscle. The accumulation of plaque deposits (atherosclerosis) in the coronary arteries can affect the blood supply, thereby leading to myocardial infarction.
Broken heart syndrome could be caused due to physical, as well as emotional stressors such as a sudden drop in the blood pressure, asthma attack, accident, intense fear or anxiety, or stress caused by unexpected loss (financial loss, losing a loved one, failed relationship), surgery, serious illness, domestic violence, etc. The symptoms that the affected individuals experience are not caused due to plaque deposits or blood clots in the coronary arteries. These occur as the surge of catecholamines (epinephrine and norepinephrine hormones) induced by stress affects the heart’s ability to pump blood. So, the heart tissue doesn’t die; the cells just get stunned due to elevated levels of adrenaline and other hormones in response to stress, anger, fear, surprise, etc. Thus, this condition can occur in individuals who don’t have any risk factors for coronary artery disease.
It must be noted that broken heart syndrome is very unlikely to cause death. However, heart failure is observed in about 20% of the cases. The reported complication rate is about 19%. Heart failure and pulmonary edema occur in 3 – 46% of patients, and mortality rate ranges between 1% and 3%.
One of the characteristic signs of this condition is the ballooning of the apical region of the left ventricle of the heart. This is mostly detected with the help of left ventricular angiography or contrast echocardiography. The stunning of the heart tissue due to stressors causes a contractile defect of the apex of the heart. During ventricular contraction, the ventricular imaging technique shows a rounded apex and a narrow, hypercontracted base. This phenomenon was first described in 1991 by Dote et al. ECG abnormalities such as ST-segment elevation or T-wave inversion must be looked into.
If medical assistance is sought on time, the symptoms caused by the heart muscle weakness resolve and the heart can recover fully. The following signs and symptoms are observed in affected individuals:
✦ Chest pain
✦ Shortness of breath
✦ Symptoms related to pulmonary edema
✦ Electrocardiogram abnormalities that might be observed in case of a heart attack
✦ No evidence of coronary artery obstruction
✦ Mild to moderate rise in the cardiac markers
✦ Abnormalities in the movement of the wall of the left ventricle
✦ Ballooning of the apical region of the left ventricle
Since the symptoms of this syndrome are similar to that of myocardial infarction, the diagnosis of broken heart syndrome is established only after diagnostic tests point towards the exclusion of coronary heart disease. Proper care must be taken to avert the development of congestive heart failure and other complications.
The defect is transient, and a full recovery is possible. However, complications could arise in some cases. The complications that have been reported include:
✦ Left ventricular failure with or without pulmonary edema
✦ Cardiogenic shock (inadequate circulation of blood in the event of inability of the ventricles to function effectively)
✦ Obstruction of the left ventricular outflow tract that connects to the aorta
✦ Ventricular arrhythmias (abnormal rate of muscle contractions of the heart, including ventricular tachycardia and ventricular fibrillation )
✦ Transient/complete atrioventricular block (heart’s electrical impulses are partially or completely blocked, when they are trying to travel from the atrial chambers of the heart to the ventricular chambers)
✦ Left ventricular mural thrombus (presence of blood clot on the wall of the left ventricle)
✦ Mitral valve regurgitation
✦ Left ventricular free wall rupture
As far as the treatment is concerned, the use of beta blockers, ACE inhibitors, and diuretics (water pills) might be recommended for patients with heart failure. It becomes extremely essential to tackle physical or emotional stress, which might be the contributing factor for this heart condition.
Most of the abnormalities in systolic function and ventricle wall movement clear up in one to four weeks, and most patients recover fully within two months. Death is rare, but heart failure occurs in about 20% of patients.
Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.