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Broken Heart Syndrome (Takotsubo Cardiomyopathy)

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Broken heart syndrome is a temporary and reversible heart condition whose symptoms mimic those of a heart attack. Unlike a heart attack, broken heart syndrome happens when a sudden physical or emotional stress causes a rapid weakening of your heart muscle.

Broken heart syndrome

You may think you’re having a heart attack because symptoms, such as shortness of breath and chest pain, are similar in both conditions. However, in broken heart syndrome, you (for the most part) don’t have blocked coronary arteries or permanent heart damage, and usually make a fast and full recovery.

Broken heart syndrome is also called stress cardiomyopathy or Takotsubo cardiomyopathy. Takotsubo is the Japanese name for an octopus trapping pot with a wide bottom and narrow neck. The pot resembles the shape of the distressed left ventricle of the heart seen in broken heart syndrome.

What kinds of emotional and physical stress can cause broken heart syndrome?

Examples of sudden emotional stressors that can bring on broken heart syndrome include:

  • Grief from the death of a loved one and other large or meaningful loss (eg, divorce/relationship, job, home, money, beloved pet).
  • Good news (e.g., surprise parties, winning the lottery).
  • Bad news.
  • Intense fear (e.g., public speaking, armed robbery, car accident).
  • Extreme anger.

Examples of sudden physical stressors that can bring on broken heart syndrome include:

  • Severe pain.
  • An exhausting physical event.
  • Health issues, including asthma attack, difficulty breathing (dypnea), seizure, stroke, high fever, low blood sugar (hypoglycemia), large blood loss, surgery.

Can I die from broken heart syndrome?

Although death has happened, it’s an extremely rare event (about 1%) and therefore highly unlikely that you will die from broken heart syndrome. In most cases, broken heart syndrome is a short, temporary condition with a full recovery.

Who is gets broken heart syndrome?

Broken heart syndrome mostly affects women (about 88%), especially in later middle age (after menopause; mean age range 58 to 77). One possible explanation is that the female hormone estrogen protects the heart against any harmful effects of hormones released in response to stress. As the level of estrogen declines with age, women might be more susceptible to the effects of sudden stress.

How common is broken heart syndrome?

The medical literature reports that broken heart syndrome occurs in about 2% of patients who were seen with a suspected heart attack. However, this figure is thought to be an underestimate of the true number of cases because the condition is often not recognized.

What causes broken heart syndrome?

The exact cause of broken heart syndrome is not fully understood. When you react to a physical or emotional stress, your body releases stress hormones in your blood like adrenalin, noradrenalin, epinephrine and norepinephrine. Experts think that these hormones temporarily interfere with your heart’s function.

Broken heart syndrome:

  • Disrupts your heart’s normal, steady rhythm (pattern of heartbeats).
  • Causes part of your heart to temporarily enlarge (the lower part of your left ventricle).
  • Leads to even more forceful contractions in other areas of your heart.

These changes cause temporary heart muscle failure.

What are the symptoms of broken heart syndrome?

You may feel symptoms within minutes up to hours after the stressful event. In broken heart syndrome, the release of stress hormones temporarily stuns your heart muscle, producing symptoms similar to a typical heart attack.

Signs and symptoms of broken heart syndrome include:

  • Sudden, severe chest pain (angina) – a main symptom.
  • Shortness of breath – a main symptom.
  • Weakening of the left ventricle of your heart – a main sign.
  • Fluid in your lungs.
  • Irregular heartbeats (arrhythmias).
  • Low blood pressure (hypotension).

A small percentage of patients diagnosed with broken heart syndrome can’t identify any stresses that may have triggered their episode.

What are the complications of broken heart syndrome?

Complications are rare, but those that have been reported include:

  • Rupture of the left ventricle (free wall) of the heart.
  • Blockage of the blood flow from the left ventricle.
  • Heart failure (your heart can’t pump enough blood to meet your body’s needs).
  • Blood clot in the wall of the left ventricle.
  • Left ventricular outflow tract obstruction.
  • Cardiogenic shock.
  • Complete atrioventricular block.
  • Death.

How is broken heart syndrome diagnosed?

After completing a physical exam and reviewing your medical history, your healthcare provider will order several tests including:

  • An EKG (electrocardiogram) to measure your heart’s electrical activity.
  • Coronary angiography (uses a dye and type of X-ray to look at your heart’s arteries).
  • Echocardiography (uses sound waves to create moving images of your heart’s pumping action).
  • Chest X-ray (shows the structure of your heart, lungs and blood vessels).
  • Cardiac MRI (magnetic resonance imaging) (produces both still and moving pictures of your heart).
  • Ventriculogram (uses a dye injected into the heart’s left ventricle, then X-rays show the size and pumping efficiency of this heart chamber).

How does broken heart syndrome differ from a heart attack?

Unlike a heart attack, in broken heart syndrome your heart muscle is not permanently damaged and your coronary arteries are not blocked.

The tests your healthcare provider orders help reveal if your symptoms are broken heart syndrome or a heart attack. You have broken heart syndrome and not a heart attack if:

  • Your symptoms appeared suddenly following a stressful physical or emotional event.
  • Your EKG was abnormal – your heart’s electrical activity showed some abnormal changes – the changes are the same as those seen during a heart attack.
  • Your blood work shows a rise in cardiac enzymes levels, the same enzymes that would be high in a heart attack.
  • The arteries supplying your heart are usually not blocked and there’s no scar tissue present in your heart.
  • The lower part of your left ventricle is enlarged – shows a ballooning of this area – and there’s unusual muscle wall movements.

How is broken heart syndrome treated?

Treatment depends on the severity of your symptoms. Broken heart syndrome is usually treated with medicines until full recovery. Medications include:

  • ACE inhibitors to lower blood pressure (long term).
  • Beta blockers to slow the heart rate (short term).
  • Diuretics to decrease fluid buildup (short term).
  • Anti-anxiety medicines to manage stress. (These medications may be long term, if needed.)

Depending on how much your heart muscle was weakened, your healthcare provider may also recommend cardiac rehabilitation. Managing your stress with yoga, meditation and other relaxation techniques can also be helpful. Ask your healthcare provider for information on these methods and possible programs and services available.

Can broken heart syndrome be prevented?

There are no known treatments for preventing broken heart syndrome. However, learning stress management and problem-solving techniques can help improve physical and emotional stress.

Engaging in relaxation techniques can also be helpful. Some examples include:

  • Practicing yoga, meditation, journaling, or mindfulness.
  • Taking a warm bath; lighting scented candles; and taking long, deep breaths and slowly exhaling.

Depending on the source of your stress, there may be a support group you can join to talk about your stress and share coping skills with others who have had similar experiences. Seeking the help of a professional counselor might be considered too.

In addition, managing physical or emotional stress can be helped by following general healthy habits too. These include:

  • Eating a healthy diet, such as the Dash diet or Mediterranean diet.
  • Getting regular exercise (at least five times a week for 30 minutes).
  • Getting seven to nine hours of sleep each night.
  • Spending time with others.
  • Keeping your medical appointments, for both follow up and preventive health screenings. Finding and treating any health problems early always leads to the best outcome for a long and healthy life.
  • Avoid – or better yet – stop unhealthy choices such as smoking, illicit drug use, and alcohol abuse.

What should I expect if I have broken heart syndrome?

Broken heart syndrome is a temporary condition for most people. You’ll likely recover without any long-term heart problems because your heart muscle is not permanently damaged. Full recovery is usually made in few days to a few weeks after your stress-induced event.

Of course if an ongoing health problem – a physical stressor like stroke, asthma or seizures – has triggered your broken heart syndrome event, you’ll need to check with your healthcare provider and further investigate or perhaps make changes to better manage these health issues.

In some cases, your healthcare provider may want to do a follow-up echocardiogram about four to six weeks after your event to make sure there’s no heart health problems and the left ventricle of your heart has returned to its normal function.

Broken heart syndrome is occasionally fatal, but this is rare.

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