The classic symptoms of a heart attack, such as squeezing chest discomfort and trouble breathing, usually occur when a blocked coronary artery chokes off part of the heart’s blood supply. But those same symptoms can arise when the coronary arteries are clear. In some of these cases, broken heart syndrome may be to blame.
Also known as takotsubo syndrome or stress cardiomyopathy, this uncommon condition usually results from severe emotional or physical stress, such as from the death of a loved one, a serious illness or surgery, or a natural disaster. Other possible triggers include a fierce argument, financial loss, intense fear, or (in rare cases) even happy emotional events such as a wedding or surprise party.
“Sudden, extreme stress can cause a surge of adrenaline that precipitates a cascade of changes to the heart that we’re just beginning to unravel,” says Dr. Malissa Wood, co-director of the Corrigan Women’s Heart Health Program at Harvard-affiliated Massachusetts General Hospital. The changes affect the heart’s muscle cells and blood vessels, temporarily altering the shape of the left ventricle, the heart’s main pumping chamber (see “A shape-shifting heart”). The heart must work harder than usual, leading to chest pain and breathlessness.
|A shape-shifting heartIn the early 1990s, Japanese doctors first described a condition in which the heart’s left ventricle takes on an unusual appearance, developing a narrow neck and a round bottom. The shape resembles a tako-tsubo (octopus pot), a traditional clay vessel a fisherman uses to trap an octopus.Because takotsubo syndrome was often preceded by emotional events, such as heartbreaking grief or intense stress, it also became known as broken heart syndrome and stress cardiomyopathy. Physical stress from an accident, illness, or surgery can also precipitate the problem, but in up to 20% of cases, no specific trigger can be identified.|
Cases in middle-aged women
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Takotsubo syndrome, which is far more prevalent in women than men, may not be as rare as once thought, according to a study published Oct. 19, 2021, in the Journal of the American Heart Association. Based on hospital data from more than 135,000 people diagnosed with takotsubo syndrome from 2006 to 2017, researchers found that the incidence rose steadily during that time. And among women ages 50 to 74, takotsubo diagnoses rose six to 10 times more rapidly than for any other demographic.
“In general, we are now better at recognizing and diagnosing all types of heart attacks in women,” says Dr. Wood. Prior to the early 2000s, heart disease was substantially underdiagnosed in women. The increase in takotsubo syndrome cases since that time probably reflects heightened awareness of the condition among cardiologists, she says. “It will be interesting to see how the incidence changes in the setting of the COVID-19 pandemic, given the extreme emotional and physical stress people have experienced.”
Diagnosing a broken heart
When people show up at an emergency room with chest pain, they receive a test that records the heart’s electrical activity (electrocardiogram) and blood tests. But with takotsubo, results from those tests may be similar to those of a regular heart attack. So doctors rely on an ultrasound of the heart (echocardiogram) to check for the characteristic change in the heart’s shape, although more invasive testing may be needed to rule out a traditional heart attack.
“The person’s history tips us off more than anything else,” says Dr. Wood. The triggering event typically occurs within minutes or hours of when the symptoms appear, she says. Although the symptoms subside quickly with treatment, the heart abnormality can persist for weeks. But the damage isn’t usually permanent, and most people recover fully within a month.
Mending a broken heart
Treating takotsubo syndrome usually involves blood pressure medications known as ACE inhibitors and beta blockers, which help lower the heart’s workload. It’s also important to address physical and emotional conditions that may have played a role in triggering the disorder, says Dr. Wood. “I make sure my patients have access to therapy or programs that can help them manage stress, such as the mindfulness and resiliency training programs at the Osher Center for Integrative Medicine and the Benson-Henry Institute.” (See www.brighamandwomens.org/osher-center/integrative-medicine-overview and https://bensonhenryinstitute.org; major academic medical centers across the country have similar programs).
Is broken heart syndrome becoming more common?
Bible verses for today’s meditation and inspiration: Matthew E. McLaren
2 Corinthians 13:9 For we rejoice when we ourselves are weak but you are strong; this we also pray for, that you be made complete.
Colossians 1:28 We proclaim Him, admonishing every man and teaching every man with all wisdom, so that we may present every man complete in Christ.
Colossians 4:12 Epaphras, who is one of your number, a bondslave of Jesus Christ, sends you his greetings, always laboring earnestly for you in his prayers, that you may stand perfect and fully assured in all the will of God.
2 Corinthians 10:15-16 not boasting beyond our measure, that is, in other men’s labors, but with the hope that as your faith grows, we will be, within our sphere, enlarged even more by you, so as to preach the gospel even to the regions beyond you, and not to boast in what has been accomplished in the sphere of another.
2 Thessalonians 1:3 We ought always to give thanks to God for you, brethren, as is only fitting, because your faith is greatly enlarged, and the love of each one of you toward one another grows ever greater;
2 Peter 3:18 but grow in the grace and knowledge of our Lord and Savior Jesus Christ To Him be the glory, both now and to the day of eternity. Amen.
Ephesians 1:17-18 that the God of our Lord Jesus Christ, the Father of glory, may give to you a spirit of wisdom and of revelation in the knowledge of Him. I pray that the eyes of your heart may be enlightened so that you will know what is the hope of His calling, what are the riches of the glory of His inheritance in the saints,
Ephesians 3:16-19 that He would grant you, according to the riches of His glory, to be strengthened with power through His Spirit in the inner man, so that Christ may dwell in your hearts through faith; and that you, being rooted and grounded in love, may be able to comprehend with all the saints what is the breadth and length and height and depth, read more
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