MUST READ ON BROKEN HEART SYNDROME

The term "broken heart syndrome" came about after researchers noticed that many people with the condition were grieving, says Ilan Wittstein, MD, a Johns Hopkins University cardiologist who's been studying the condition for a decade.

"The first several patients we saw, many of them had [just experienced] the death of a loved one, a spouse, a parent. Some people started having symptoms at a funeral," he tells WebMD.

But other patients had just gone through a trauma like a car accident or a mugging. Another woman landed in the intensive care unit on her 60th birthday after being startled by well-wishers shouting "Surprise!" Wittstein says.

Broken heart syndrome is a temporary heart condition that's often 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. In broken heart syndrome, there's a temporary disruption of your heart's normal pumping function, while the remainder of the heart functions normally or with even more forceful contractions.
Broken heart syndrome may be caused by the heart's reaction to a surge of stress hormones. The condition may also be called takotsubo cardiomyopathy, apical ballooning syndrome or stress cardiomyopathy by doctors.
The symptoms of broken heart syndrome are treatable, and the condition usually reverses itself in about a week.

These types of events can trigger your sympathetic nervous system, which is also called your "fight or flight" mechanism, says Peter Shapiro, MD, a professor of clinical psychiatry at Columbia University who studies emotional issues in heart disease.

Your body unleashes a flood of chemicals, including adrenaline, he says. This sudden flood can stun your heart muscle, leaving it unable to pump properly.

So even though broken heart syndrome may feel like a heart attack, it's a very different problem that needs a different type of treatment.

The Shape of a Broken Heart

Broken heart syndrome has yet another name: Takotsubo syndrome.

A tako-tsubo is a pot that's used in Japan for catching sea creatures. When Japanese researchers looked at images of people's hearts during broken heart syndrome, they noted that the left ventricle had taken on an unusual shape resembling the fishing pot.

During an episode of the condition, the heart muscle can be so profoundly affected that it can't pump blood out to the body strongly enough. As a result, the patient may develop heart failure. This can be life-threatening, Wittstein says.

Symptoms

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

• Chest pain
• Shortness of breath
• Arm pain
• Sweating

 
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
• Natural disasters
• A surprise party
• Having to perform publicly
• Job loss
• Divorce
• Physical stressors, such as an asthma attack, a car accident or major surgery

It's also possible that some drugs, rarely, may cause broken heart syndrome by causing a surge of stress hormones. Drugs that may contribute to broken heart syndrome include:

• Epinephrine (EpiPen, EpiPen Jr), which is used to treat severe allergic reactions or a severe asthma attack
• Duloxetine (Cymbalta), a medication given to treat nerve problems in people with diabetes, or as a treatment for depression
• Venlafaxine (Effexor XR), which is a treatment for depression
• Levothyroxine (Synthroid, Levoxyl), a drug given to people whose thyroid glands don't work properly

How is broken heart syndrome different from a heart attack?

Heart attacks are generally 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:

• Backup of fluid into your lungs (pulmonary edema)
• Low blood pressure (hypotension)
• Disruptions in your heartbeat

It's also possible that you may have broken heart syndrome again if you have another stressful event. However, the odds of this happening are low.

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, as most can be stopped after a while.
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 small 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. Recognizing and managing stress in your life also is very important.

A Healed Heart

A remarkable aspect of broken heart syndrome is that "someone can be critically ill on a Monday, and by Thursday can literally be preparing to go home," Wittstein says.

Their heart muscle also usually recovers fairly quickly. Neither is often the case after a major heart attack.

Afterward, people may need to take heart medications called beta blockers or ACE inhibitors for a limited time. However, experts don't know if these drugs are necessary for the long term, Wittstein says.

Since her episode, Lisa hasn't had any more heart problems, and she's only taking a low dose of an anti-anxiety drug. These days, she spends her time authoring books, helping people with disabilities ride horses, and leading a foundation in Colby's name. She's grateful that her doctors were able to diagnose her condition as a short-term problem.

"What was so reassuring to me was that the doctor didn't dismiss the symptoms just because I wasn't having a heart attack. He understood my symptoms were real. That was very comforting to me," she says.