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Broken Heart Syndrome

A broken heart syndrome is a form of cardiomyopathy with abrupt onset caused by extreme emotional distress. Medically, this condition is known as stress cardiomyopathy or Takotsubo cardiomyopathy,

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A broken heart syndrome is a form of cardiomyopathy with abrupt onset caused by extreme emotional distress. Medically, this condition is known as stress cardiomyopathy or Takotsubo cardiomyopathy, first described by a Japanese physician in 1990. The term Takotsubo comes from a Japanese apparatus used to trap squids because the affected hearts assume a similar ballooning shape as seen through cardiac catheterization during contrast injection.

Causes
The actual cause of this condition remains unclear.  However, it is believed that an increase in stress hormones such as adrenaline could trigger the need for energy and oxygen that cannot be met by the available blood supply leading to heart dilatation due to heart muscle weakness and heart failure. The stressful circumstances could be from illnesses or severe physical or emotional trauma such as the unexpected loss of a loved one. Despite being called a broken heart syndrome, it is more often caused by physical trauma than emotional distress; and is more frequent in females.

Symptoms
Symptoms of broken heart syndrome include chest pain and shortness of breath, edema, and inability to lie flat due to inadequate heart muscle pumping that closely mimics a heart attack. Death may ensue in severe cases, especially with significant physical injuries.

Diagnosis
Besides detailed history taking and physical examination, special cardiac assessment with an electrocardiogram (EKG), blood tests, Chest X-ray, and echocardiogram are required. The EKG and cardiac enzyme changes are indistinguishable from heart attack patients. The definitive diagnosis requires a cardiac catheterization with a coronary angiogram, typically normal in broken heart syndrome.

Treatment
Since patients with broken heart syndrome have normal coronary arteries, there is no need for balloon angioplasty as in patients with coronary artery disease suffering from a heart attack. The treatments are supportive with medications to maintain blood pressure, heart rate, and blood oxygenation level and treat any physical injuries that may precipitate the syndrome. Most will recover in 4-8 weeks.

The doctor will prescribe medications to help with the reduction of heart muscle force of contraction and prevent future sequelae, such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), beta-blockers, diuretics, and blood thinners if the patient has a blood clot in the heart.

Cardiac interventional procedure
Usual procedures for treating heart attack, including balloon angioplasty and stent placement, will not help in treating broken heart syndrome as these procedures aim to treat artery blockage, which is not the cause of broken heart syndrome.

Preparing for the doctor’s appointment
The patient should seek immediate medical attention or have someone take them to the emergency room if they experience unexplained chest pain. Also, coming to the hospital with a family member is essential.

Information that should be on hand before the visit includes:

  • List all symptoms the patient is experiencing and how long they have had them.
  • List all personal information, including any significant changes or stressors in life, such as the death of a loved one or a job loss.
  • List all personal and family medical history, including other health conditions like diabetes, high cholesterol, or heart disease.
  • List all prescription and nonprescription drugs the patient is currently taking.
  • List any recent chest injury that may cause internal injuries, including a broken bone or pinched nerve.

The doctor will check the patient’s symptoms based on ECG and blood test results to determine if the patient has this condition or a heart attack.

Questions patient may ask the doctor: 

  • What is the cause of the syndrome?
  • I have experienced significant life changes; could this be the cause?
  • What tests do I need to take?
  • Do I need to be hospitalized? 
  • What are the treatments that I need?
  • Can this recur?
  • Are there any restrictions such as diet or exercise that I need to follow?

What to expect from the doctor?
Some of the questions the doctor could’ve asked are as follow: 

  • What symptoms are you experiencing?
  • When did it begin?
  • Is the pain localized to one area, or does it radiate to other body areas?
  • Does the pain increase synchronize with the heartbeat?
  • Can you describe your pain?
  • Do your symptoms worsen by exercise? 
  • Do any of your family members have a history of heart problems?
  • Are you under treatment for any illness, or have you been previously treated for any other diseases?

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Published: 21 Jul 2022

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