Broken Heart Syndrome

“Death leaves a heartache no one can heal, Love leaves a memory no one can steal.

Sometimes a broken heart can be healed with time but it can also take your life away”

Broken heart syndrome is also called as Stress-induced Cardiomyopathy or Takotsubo Cardiomyopathy, can strike even if you’re healthy. (Tako tsubo, by the way, is octopus traps that resemble the pot-like shape of the stricken heart.) It is a sudden transient cardiac syndrome that involves dramatic left ventricular apical akinesis and mimics acute coronary syndrome.

What Triggers a Broken Heart Syndrome?

There are a million reasons for one to develop broken heart syndrome. However, some common ones include –

- - - Emotional stress such as the death of a loved one or loss of a job
    - Extreme physical stress major surgery, a sudden drop in blood pressure, serious illness, surgery, or medical procedures (e.g., cardiac stress test), severe pain, domestic violence, asthma attack
    - Receiving bad news such as a diagnosis of cancer
    - Accidents
    - Unexpected loss, illness, or injury of a close relative, friend, or pet
    - Fierce argument
    - Financial loss
    - Intense fear

It is thought that an excess of hormones such as Adrenaline (a hormone which is released in reaction to extreme stress) due to a stressful scenario affects the heart and causes a temporary change in the way it works.

Who is More Susceptible?

Women are more prone than men to the symptoms of broken heart syndrome, particularly Asian and Caucasian postmenopausal women. Often, a person experiencing broken heart syndrome has never shown a sign of heart disease and has been previously healthy.

What are the Symptoms of Broken Heart Syndrome?

Sudden intense chest pain
Shortness of breath caused by the heart not being able to pump properly which causes fluid to pump which causes fluid to build up in the lungs and arrhythmia (abnormal heart rhythms)- where the heart beats too fast or too slow or may beat irregularly.
Cardiogenic shock (An inability of the heart to pump enough blood to meet the body’s demands. The impact of stress hormones ‘stuns’ the cells of the heart causing them to malfunction. These effects usually wear off within a few days or at most weeks and there is no lasting heart damage.
Fainting
Low blood pressure
Heart failure
Drugs which cause a surge in the stress hormones like –

-Epinephrine(which is used to treat severe allergic reactions or a severe asthma attack)

-Duloxetine(which is used to treat nerve problems in people with diabetes and depression)

-Venlafaxine(which is used to treat for depression)

-Levothyroxine(which is used to treat people dysfunctioning of thyroid glands)

-Unprescribed or illegal stimulants such as methamphetamine and cocaine

Are There any Risk Factors?

There are a few risk factors that increase one’s chance of developing broken heart syndrome, such as:

Sex – The condition affects women far more often than men.
Age– It appears that most people who have broken heart syndrome are older than 50.
History of a neurological condition– People who have neurological disorders, such as a head injury or a seizure disorder (epilepsy) have a greater risk of broken heart syndrome.
Previous or current psychiatric disorder – If you’ve had a history of disorders, such as anxiety or depression, probably have a higher risk of broken heart syndrome

How Can One Differentiate Broken Heart Syndrome and a Heart Attack?

Symptoms of broken heart syndrome appear suddenly, following a stressful event
An EKG will show the heart’s electrical activity is not normal but is not the same as the changes seen during a heart attack
Blood tests show no damage to the heart
The arteries of the heart are not blocked
The left ventricle (lower left chamber of the heart) shows enlargement and unusual contractions that are not present in a heart attack
Cardiac biomarkers (substances released into the blood when the heart is damaged or stressed) are higher than normal but are not as high as when having a heart attack

What About Treatment?

Initially, the symptoms of broken heart syndrome will be treated like those of a heart attack. Once a diagnosis is made, broken heart syndrome is treated with medicines such as ACE inhibitors to lower blood pressure, beta-blockers to slow the heart rate, diuretics to decrease fluid buildup, and anti-anxiety medicines to manage stress.

Treatments such as angioplasty, stent placement, and surgery are used to treat a heart attack but are NOT used in cases of broken heart syndrome because they address the problem of blocked arteries, which is not found in broken heart syndrome.

Can One Suffer from Complications?

Yes, at times, a broken heart syndrome can lead to serious heart problems. Some of these include –

Failure of the heart to be able to pump enough blood to meet the body’s needs
Heartbeat patterns that are much faster or slower than normal
Damage to heart valves
Backup of fluid in the lungs
Low blood pressure

Can it be Prevented?

There are no known treatments for preventing broken heart syndrome but learning stress management, problem-solving, and relaxation techniques can help improve both psychological and physical health. Managing stress can also be improved with Physical exercise, Yoga, Meditation and Anxiety medications. It is also important to avoid poor choices in managing stress such as drinking, overeating, illicit drug use or smoking.

How is Prognosis?

Although broken heart syndrome can occasionally be fatal, most people recover within days or weeks. There is no permanent damage to the heart muscle, and there is a low risk for having a recurrence (not more than 10%of cases).

The doctor may recommend a follow-up echocardiogram about 4 to 6 weeks after discharge from the hospital, and other visits to the doctor may be required depending on the specifics of the patient’s case.