Thursday's Therapy - Can You Die of a Broken Heart? ~Washington Post / Answering Questions Regarding "Broken Heart Syndrome" ~Johns Hopkins University

Broken heart syndrome,

also called stress-induced cardiomyopathy

or takotsubo cardiomyopathy,

can strike even if you're healthy.

People dealing with a great loss of a loved one,

divorce, physical separation, anxiety everyday

brought on by stress. Causes are

brought on by a stressful emotional event.

You can die of a broken heart -- it's scientific fact!

Thursday's Therapy

Can You Die of a Broken Heart?

~Washington Post

/

Answering Questions Regarding

"Broken Heart Syndrome"

~Johns Hopkins University

Viewer Discretion Is Advised.

~X-ray of "Broken Heart Syndrome"

~U.S. National Library of Medicine

~~~~~

Study Suggests 

You Can Die of a Broken Heart

Stress Hormones Cause Fatal Spasms, 

Scientists Find

By Rob Stein

Washington Post Staff Writer

Thursday, February 10, 2005; Page A03

As Valentine's Day approaches, scientists have confirmed the lament of countless love sonnets and romance novels: People really can die of a broken heart, and the researchers now think they know why.

A traumatic breakup, the death of a loved one or even the shock of a surprise party can unleash a flood of stress hormones that can stun the heart, causing sudden, life-threatening heart spasms in otherwise healthy people, researchers reported yesterday.

The phenomenon can trigger what seems like a classic heart attack and can put victims at risk for potentially severe complications and even death, the researchers found. By giving proper medical care, however, doctors can mend the physical aspect of a "broken heart" and avoid long-term damage.

"When you think about people who have died of a 'broken heart,' there are probably several ways that can happen," said Ilan S. Wittstein of the Johns Hopkins School of Medicine in Baltimore, whose findings appear in today's New England Journal of Medicine. "A broken heart can kill you, and this may be one way."

No one knows how often it happens, but the researchers suspect it is more frequent than most doctors realize -- primarily among older women -- and is usually mistaken for a traditional heart attack.

That is what happened to Sylvia Creamer, 73, of Walkersville, Md., who experienced sudden, intense chest pain after giving an emotional talk about her son's battle with mental illness.

"I started having this heavy sensation just pushing down on my chest," said Creamer, who was taken to a hospital where doctors began treating her for what they thought was a heart attack. But Creamer's arteries were fine, and Wittstein and his colleagues subsequently determined that she had instead experienced an unusual heart malfunction. She quickly recovered.

The idea that someone can die from a broken heart has long been the subject of folklore, soap operas and literature. Researchers have known that stress can trigger heart attacks in people prone to them, and a syndrome resembling a heart attack in otherwise healthy people after acute emotional stress has been reported in Japan. But very little was known about the phenomenon in this country, and no one had any idea how it happened.

The new insight is perhaps the most striking example of the link between mind and body, several experts said.

"This is another in a long line of accumulating, well-documented effects of stress on the body," said Herbert Benson, a mind-body researcher at Harvard Medical School. "Stress must be viewed as a disease-causing entity."

The findings also underscore the growing realization that there are fundamental physiological differences between men and women, including how they respond to stress.

"This is why we need to do more research involving women," said cardiologist Deborah Barbour, speaking on behalf of the American Heart Association. "We can't extrapolate a man's response to a woman."

It remains unclear why women would be more vulnerable, but it may have something to do with hormones or how their brains are wired to their hearts.

"Women react differently to stress, particularly emotional stress. We see that in our daily lives," said Scott W. Sharkey of the Minneapolis Heart Institute, who described 22 similar cases last week in the journal Circulation.

Accurately diagnosing the phenomenon, known technically as stress cardiomyopathy, should help improve treatment for patients who might otherwise receive drugs or other therapies that could do more harm than good, Sharkey and others said.

Wittstein and his colleagues studied 19 patients who had what appeared to be traditional heart attacks between 1999 and 2003 after experiencing sudden emotional stress, including news of a death, shock from a surprise party, being present during an armed robbery and being involved in a car accident. All but one were women. Most were in their sixties and seventies, though one was just 27. None had a history of heart problems.

When the researchers compared them with people who had classic heart attacks, they found that they had healthy, unclogged arteries but that levels of stress hormones in their blood, such as adrenaline, were two to three times as high as in the heart attack victims -- and seven to 34 times higher than normal.

"Our hypothesis is that massive amounts of these stress hormones can go right to the heart and produce a stunning of the heart muscle that causes this temporary dysfunction resembling a heart attack," Wittstein said. "It doesn't kill the heart muscle like a typical heart attack, but it renders it helpless."

Tests also found distinctive patterns in the electrical firing and contractions of the hearts of those who experienced the syndrome, which should enable doctors to diagnose the condition quickly, Wittstein said.

While victims of classic heart attacks often experience long-lasting damage and take weeks or months to recover, these patients showed dramatic improvement within a few days and complete recovery with no lingering damage within two weeks.

That was the case for Meg Bale, 70, of Bloomington, Minn., who had an attack after Sen. Paul D. Wellstone (D-Minn.) died in a plane crash in 2002. She began experiencing severe chest pain that shot down her arm after attending an emotional gathering at Wellstone's office, and she ended up being taken to an emergency room.

"For me, it was just such a shock. I really thought he was something special -- he had real heart," Bale said. "I felt just awful."

~Washington Post

~~~~~

Frequently Asked Questions about Broken Heart Syndrome

For more information on Stress Cardiomyopathy, visit the Johns Hopkins Heart and Vascular Institute's website.

1. What is "stress cardiomyopathy"?

Stress cardiomyopathy, also referred to as the “broken heart syndrome,” is a condition in which intense emotional or physical stress can cause rapid and severe heart muscle weakness (cardiomyopathy). This condition can occur following a variety of emotional stressors such as grief (e.g. death of a loved one), fear, extreme anger, and surprise. It can also occur following numerous physical stressors to the body such as stroke, seizure, difficulty breathing (such as a flare of asthma or emphysema), or significant bleeding. 

           

2. What are the symptoms of stress cardiomyopathy?

Patients with stress cardiomyopathy can have similar symptoms to patients with a heart attack including chest pain, shortness of breath, congestive heart failure, and low blood pressure. Typically these symptoms begin just minutes to hours after the person has been exposed to a severe, and usually unexpected, stress.

           

3. Is stress cardiomyopathy dangerous?

Stress cardiomyopathy can definitely be life threatening in some cases. Because the syndrome involves severe heart muscle weakness, patients can have congestive heart failure, low blood pressure, shock, and potentially life-threatening heart rhythm abnormalities. The good news is that this condition improves very quickly, so if patients are under the care of physicians familiar with this syndrome, even the most critically ill tend to make a quick and complete recovery.

4. How does sudden stress lead to heart muscle weakness?

First, it is important to understand what “stress” is. “Stress” refers to the body’s response to things it perceives as abnormal. These abnormalities can be physical such as high body temperature, dehydration, or low blood sugar, or can be emotional, such as receiving news that a loved one has passed away. When these abnormalities occur, the body produces various hormones and proteins such as adrenaline and noradrenaline which are meant to help cope with the stress. For example, if a person is suddenly threatened and fears physical harm, the body produces large amounts of adrenaline to help that person either defend himself/herself or run faster to escape the danger. With stress cardiomyopathy, we believe that the heart muscle is overwhelmed by a massive amount of adrenaline that is suddenly produced in response to stress. The precise way in which adrenaline affects the heart is unknown. It may cause narrowing of the arteries that supply the heart with blood, causing a temporary decrease in blood flow to the heart. Alternatively, the adrenaline may bind to the heart cells directly causing large amounts of calcium to enter the cells which renders them temporarily dysfunctional. Whichever the mechanism, it appears that the effects of adrenaline on the heart in this syndrome are temporary and completely reversible. As will be discussed further in question 5, one of the main features of this syndrome is that the heart is only weakened for a brief period of time and there tends to be no permanent or long-term damage.

5. How does stress cardiomyopathy differ from a heart attack?

Stress cardiomyopathy can easily be mistaken for heart attack. Patients with this syndrome can have many of the same symptoms that heart attack patients have including chest pain, shortness of breath, congestive heart failure, and low blood pressure. With a closer look, however, there are some major differences between the two conditions. First, most heart attacks occur due to blockages and blood clots forming in the coronary arteries, the arteries that supply the heart with blood. If these clots cut off the blood supply to the heart for a long enough period of time, heart muscle cells can die, leaving the heart with permanent and irreversible damage. This is completely different from what is seen with stress cardiomyopathy. First, most of the patients with stress cardiomyopathy that both we and others have seen appear to have fairly normal coronary arteries and do not have severe blockages or clots. Secondly, the heart cells of patients with stress cardiomyopathy are “stunned” by the adrenaline and other stress hormones but not killed as they are in heart attack. Fortunately, this stunning gets better very quickly, often within just a few days. So even though a person with stress cardiomyopathy can have severe heart muscle weakness at the time of admission to the hospital, the heart completely recovers within a couple of weeks in most cases and there is no permanent damage.

   

6. I am under a great deal of stress every day. Is it possible that I have been walking around with stress cardiomyopathy and did not even know it?

While there is no debate that chronic stress can have effects on human health, stress cardiomyopathy appears to be a condition that comes on suddenly and unexpectedly and resolves quite quickly. If you are a person who frequently has symptoms of chest pain or shortness of breath when under significant stress, you should be evaluated by your doctor. He or she may want to perform some basic tests to make sure you are in god health. It is unlikely, however, if your symptoms have been going on for a while that you have stress cardiomyopathy.

   

7. Who is at risk for getting stress cardiomyopathy?

Because stress cardiomyopathy is a relatively newly appreciated syndrome, we are only beginning to understand why it happens and who is most likely to get it. Most of the patients we have seen with it do not have a previous history of heart disease. It is quite clear from the available medical literature so far, however, that stress cardiomyopathy affects primarily women. In addition, it tends to occur most frequently in middle aged or elderly women (average age about 60). While it can also occur in young women and even in men, the vast majority of the patients we have seen with this are post-menopausal women. The exact reason for this is unknown, and further research will be necessary to help explain this observation.

8. Once a person has had stress cardiomyopathy, will they get it again the next time they are under severe stress?

From what we have seen so far, the answer to this question appears to be no. While it is possible that the syndrome could recur, this is not what we have observed at our hospital. In the five years that we have been following patients with stress cardiomyopathy, none have experienced the syndrome a second time. Further, several of our patients went on to have other stressful events in their lives and none developed the syndrome again.

9. If I have had stress cardiomyopathy, what is my long-term prognosis?

Because the heart muscle is not permanently damaged with this syndrome, patients typically make a rapid and complete recovery. From our experience and from what has been published by other groups, the long-term prognosis for patients with stress cardiomyopathy appears to be excellent.

~Johns Hopkins University

Pictures:
Conglomerate of pictures on Broken Heart Syndrome, by ~Grieving Mothers
X-Ray: ~U.S. National Library of Medicine X-ray of "Broken Heart Syndrome"

Broken Heart Syndrome articles used:

Washington Post:
http://www.washingtonpost.com/wp-dyn/articles/A11446-2005Feb9.html

Johns Hopkins University:
http://www.hopkinsmedicine.org/asc/faqs.html

Broken Heart Syndrome X-Ray may be found at
http://abcnews.go.com/Health/slideshow/photos-xray-medical-scans-2033647