written by Dr. A. C. Mankwe (MBBCH, MSc, FWACP)
Stress is a complex series of reactions, both psychological and physical, in response to demanding or threatening situations.
Chronic stress increases the risk of cardiovascular disease such as heart attack and broken heart syndrome otherwise known as takotsubo cardiomyopathy, apical ballooning syndrome or stress cardiomyopathy.
Broken heart syndrome is a temporary disorder of the heart that often results from stressful situations, such as the death of a loved one, unhealthy relationship, living situation etc. The condition can also be precipitated by a debilitating illness or surgical operation.
Individuals with broken heart syndrome may have acute chest pain which most often mimics a heart attack.
In broken heart syndrome, there’s a transient disruption of ones heart’s ability to pump adequate amount of blood to meet the metabolic needs of the body due to a defect in one area of the heart. The other areas of the heart work normally or may even increase in their force of contraction.
Broken heart syndrome may also result from the heart’s reaction to an increase elaboration of stress hormones.
It is a preventable and treatable medical condition, and it usually reverses itself in days or weeks.
Broken heart syndrome symptoms can resemble that of a heart attack.
Common symptoms include:
Chest pain, irregular heart beat resulting in awareness of heart beat (palpitation) and difficulty in breathing
Any prolonged chest pain could be a sign of a heart attack, and so it’s important to take it seriously and consult your Doctor.
The specific cause of broken heart syndrome is not clear. It’s been proposed that a surge of stress hormones, such as adrenaline, might temporarily damage the hearts of some people.
The exact mechanism how these hormones affect the heart or whether something else is responsible is completely unclear. A transient narrowing of the large or small arteries of the heart has been implicated in the aetiopathogenesis.
Broken heart syndrome is often preceded by an intense physical or emotional event.
Some potential triggers of broken heart syndrome are:
· Increased responsibility
· Major life changes (marriage, divorce, relationship troubles, childbirth, death of loved ones, etc.)
· Financial pressures
· Job changes/Loss of job
· Natural and man-made disasters (Flooding, Boko Haram Insurgency)
· And many other factors
Some drugs, rarely, may cause broken heart syndrome by causing a surge of stress hormones. Drugs that have been linked with broken heart syndrome include:
- Epinephrine, which is used to treat severe allergic reactions or a severe asthma attack
- Levothyroxine, a drug given to people whose thyroid glands don’t work properly
- Duloxetine, a medication given to treat nerve problems in people with diabetes, or as a treatment for depression
- Venlafaxine, which is a treatment for depression
There are a number of known risk factors for broken heart syndrome, including:
- 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.
- A 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.
- A previous or current psychiatric disorder. If you’ve had disorders, such as anxiety or depression, you probably have a higher risk of broken heart syndrome.
In rare cases, broken heart syndrome is fatal. However, most that 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
- Heart failure
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.
These exams and tests are used to make a diagnosis of broken heart syndrome in suspected cases:
Personal history and physical exam.
Your doctor will want to know about your medical history, especially whether you’ve ever had heart disease symptomsin addition to a standard physical exam. People who have broken heart syndrome usually don’t have any heart disease symptoms before they’re diagnosed with broken heart syndrome. Also, your doctor will want to know if you’ve experienced any major stresses recently, such as the death of a loved one, divorce, loss of job etc.
This is a noninvasive test performed by a technician by placing wires on your chest that record the electrical impulses that make your heart beat. An ECG records these electrical signals and can help your doctor detect irregularities in your heart’s rhythm and structure.
Your doctor may also order a heart scan called echocardiography to see if your heart is enlarged or has an abnormal shape, a sign of broken heart syndrome. This noninvasive exam shows detailed images of your heart’s structure and function.
Most people who have broken heart syndrome have an increased amount of certain enzymes in their blood. Your doctor may order blood tests to check for these enzymes to help diagnose broken heart syndrome.
Your doctor will likely order a chest X-ray of your chest to see if your heart is enlarged or has the shape that’s typical of broken heart syndrome, or to see if there are any problems in your lungs that could be causing your symptoms.
Cardiac magnetic resonance imaging (MRI).
For this test, you lie on a table inside a long tube-like machine that produces a magnetic field. The magnetic field produces detailed pictures to help your doctor evaluate your heart.
During a coronary angiogram, a type of dye that’s visible by X-ray machine is injected into the blood vessels of your heart. Then, an X-ray machine rapidly takes a series of images (angiograms) that give your doctor a detailed look at the inside of your blood vessels.
Because broken heart syndrome often mimics the signs and symptoms of a heart attack, a coronary angiogram may be done quickly to rule out a heart attack. People with broken heart syndrome often don’t have any blockages in the blood vessels, while people who’ve had a heart attack usually have a blockage that is visible on an angiogram.
Once it’s clear you’re not having a heart attack, your doctor will check to see if your signs and symptoms were caused by broken heart syndrome.
There’s no specific treatment for 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 a month or so. Ask your doctor how long you will need to continue taking these medications once you recover, as most can be stopped within three to six months.
Procedures that are often used to treat a heart attack, such as balloon angioplasty and stent placement, or even surgery, aren’t helpful in treating broken heart syndrome. These procedures treat blocked arteries, which are not the cause of broken heart syndrome. But, coronary angiography can be used to diagnose the cause of the chest pain.
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.
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 may also be important in helping to prevent broken heart syndrome, though there’s currently no evidence to prove this.
Lastly, if we obey God’s word that says
“do no panic or have anxiety over anything, but by prayer, supplication and thanksgiving, we should make our request known to Him. (Philippians 4:6)”
we shall be shielded from the scourge of broken heart syndrome.