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Doctor at the Desk

Broken Heart Syndrome: When a Broken Heart Looks Like a Heart Attack

By: Stef dela Cruz, MD article_17

“The shattering of a heart when being broken is the loudest quiet ever.” – Carroll Bryant

Such is the paradox of love: It gives pleasure as much as it does pain. It also robs us of our dignity, regardless of how seemingly dignified we are – you and I are no strangers to how broken hearts can lead to drunk text messages, unlimited tears, and angry tirades on Facebook.

Nothing quite brings out the ugly like a broken heart. Adding injury to insult (instead of the other way around), it can bring about more than just a complete emotional breakdown.

Case in point: broken heart syndrome, which involves a literally sick heart! In this syndrome, a broken heart becomes a health condition, surpassing its proverbial meaning by functioning like it has truly broken down.

If the “broken” heart is left to its own devices, the sad story transforms into one of tragedy and death. As poetically poignant as that sounds, there is nothing romantic about stress-induced cardiomyopathy, which is what happens in broken heart syndrome so named, by the way, because it can happen to people grieving a terrible loss and nursing a broken heart.

When the heart breaks (and breaks down)

Is it really possible for a healthy heart to manifest with signs and symptoms of heart disease, just because of a broken heart? The answer – which you probably already know – is yes.

Because it often mimics a heart attack, broken heart syndrome is not easily recognized and, as a result, underreported. To diagnose this syndrome, take these facts to heart (pun intended).

1. A “broken heart” looks like a Japanese octopus trap

Broken heart syndrome is also called tako-tsubo cardiomyopathy because of how the heart’s left ventricle appears in imaging studies: like a Japanese tako-tsubo or an octopus-trapping pot that is wider at the bottom, as reported by Hikaru Sato and colleagues in 1990.

Echocardiography or x-ray studies will reveal apical ballooning of the left ventricle, a reversible phenomenon according to a 2010 article by Harvard Women’s Health Watch. As the heart contracts, the apex and middle section of the left ventricle balloons out, mimicking the appearance of a tako-tsubo.

One of the four criteria for diagnosis, as suggested by the Mayo Clinic, is abnormal movement in the left ventricle wall identified in imaging studies, usually accompanied by a stressful trigger, according to Yoshihiro Akashi and colleagues in a 2008 article published in Circulation.

However, an angiography will reveal no signs of coronary vessel obstruction or plaque rupture, which happens to be the second criterion.

Other criteria are:

  • New electrocardiograph (ECG) abnormalities, such as ST-segment elevation and/or T-wave inversion, or modest elevation in cardiac troponin
  • Absence of myocarditis and pheochromocytoma

2. The syndrome is triggered by severe stress

Masquerading as a heart attack, broken heart syndrome is usually triggered by stressors. A person who suddenly receives bad news or even mourns the loss of a pet may suffer from this syndrome.

There are many other stressors linked to broken heart syndrome, such as domestic violence, severe pain, money matters, fear, or even a major argument.

However, some stressors are way too subtle to be identified even after careful history taking, according to a 2011 multi-center study by Ingo Eitel and team published in the Journal of the American Medical Association. For every one out of three people, no clear stressor could be identified.

3. You can be absolutely healthy and still get it

Eating your vegetables and exercising regularly protects you from a heart attack. It’s too bad that there’s no such reassurance when it comes to broken heart syndrome.

Even a healthy person without clogged arteries or heart disease can still get it. Despite being free of risk factors for heart disease, one can still suffer from stress-induced cardiomyopathy.

4. Women are more likely to have it…

While we no longer subscribe to gender stereotypes such as women being more emotional when it comes to love problems, broken heart syndrome begs to differ. It occurs mostly in females, further proving the differences between a man and a woman’s physiology, especially when it comes to cardiac health.

The syndrome was documented more often in post-menopausal women 50 years old and above. According to Monica Gianni and colleagues in a 2006 systematic review published in the European Heart Journal, this increased risk for broken heart syndrome in women may be due to female hormones, which can affect the sympathetic nervous system and lead to coronary vessel reactivity.

After menopause, a woman’s lower estrogen levels may also contribute to altered endothelial function, as explained by Stefano Taddei and team in a 1996 article published in Hypertension.

5. …But anyone can get it

Nobody is immune to a broken heart. The same can be said about broken heart syndrome.

Even men and younger ladies can still get stress-induced cardiomyopathy, according to Eitel and colleagues. Out of more than 250 people diagnosed with broken heart syndrome, 11 percent were male and 8 percent were women in childbearing age.

6. You are likely to survive it

Good news: If your broken heart comes bundled with the syndrome, you will probably live to tell about it! Only about 1 to 3 percent of all patients succumb to the condition, reported Gianni and colleagues.

In fact, almost 95 percent recover in just one to two months, according to Thomas Pilgrim and Thomas Wyss in a 2008 systematic review published in the International Journal of Cardiology.

Complications may include shock, left heart failure, left ventricular outflow obstruction, mitral regurgitation, arrhythmias, left ventricular free wall rupture, and thrombus formation in the left ventricle.

7. You may get it when you’re extremely sad… or extremely happy

Because love is the oddest paradox, it’s no surprise that even happy moments can lead to tako-tsubo syndrome.

Dubbed happy heart syndrome this time around, it possesses almost the same elements as broken heart syndrome. Even the lab results and outcomes of both syndromes are nearly identical, according to Jelena Ghadri and colleagues in a 2016 study published in the European Heart Journal.

It can be triggered by events that people often report as positive, such as a child’s wedding, surprise parties, and receiving news that one is about to be a grandparent. The authors theorized that positive, happy moments might have the same emotional pathways as the negative stressors identified in broken heart syndrome.

Surviving a broken heart

Most doctors can’t immediately tell the difference between broken heart syndrome and an actual heart attack until the results are in. Initial ECG results may look like those found in myocardial infarction, which is why it is often initially treated as so.

Once identified, treatment is usually supportive. Repeat imaging may be needed and beta-blocker therapy can help. A left ventricle thrombus, found in about 5 percent, will necessitate anticoagulant therapy, according to a 2009 article by Satoshi Kurisu and colleagues published in the International Journal of Cardiology.

However, despite the development of complications, you are likely to survive broken heart syndrome!

I am tempted to say the same for a mere broken heart, but I can’t. It’s arguably a lot more complicated than the syndrome it was named after – just ask someone whose broken heart has led to drunk text messages, unlimited tears, and angry tirades on Facebook.


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Keywords: myocardial infarction, happy heart syndrome, altered endothelial function, coronary vessel reactivity, cardiac health, angiography, echocardiography, tako-tsubo cardiomyopathy, heart attack, stress-induced cardiomyopathy, broken heart syndrome   
  
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