BROKEN HEART SYNDROME - IS IT REAL?
They say a broken heart can kill, but is this the truth or just a myth propagated by a romantic. Is broken heart syndrome real or a setback in your life incapable of causing pathological changes to the structure of your heart? Broken heart syndrome is indeed real and can affect anybody, healthy or not, at any point in life.
Also referred to as Takotsubo cardiomyopathy, stress cardiomyopathy, and apical ballooning syndrome, broken heart syndrome is a heart condition that temporarily weakens the heart muscles, resulting in symptoms similar to that of a heart attack. However, stress cardiomyopathy does not affect the entire heart but rather only a part of it. The rest of the heart muscles compensate for this injury by contracting with even greater force.
It is hard to determine precisely how common broken heart syndrome is because the patients and doctors often mistake it for a heart attack. It is safe to say that the recorded data about the rates of broken heart syndrome is significantly lower than the actual numbers since the condition isn't diagnosed easily and is often misdiagnosed.
According to case reports and reviews, the current literature states that approximately two percent of all heart attack cases are actually broken heart syndrome mimicking a heart attack. Statistics indicate that it affects women more than men. While it can affect anyone at any age, most of the cases are reported amongst those over 50 years of age.
Most of the time, older women suffer from broken heart syndrome after losing a loved one or undergoing surgery, putting their bodies through psychological and physical stress, respectively. However, in almost 33 percent of the cases, a specific cause cannot be determined for stress cardiomyopathy.
As one of the other names for broken heart syndrome, stress cardiomyopathy implies, the leading cause of the condition is stress. Two different types of stress can result in broken heart syndrome, namely, physical and emotional.
It is not clear exactly how stress causes broken heart syndrome. Still, it is known that eventually, there is an alteration in the structure of the heart muscles and a reversible change in the ability of the heart to perform its function. It is hypothesized that the surge of stress hormones damages parts of the heart; however, there is no evidence supporting this hypothesis.
Another potential mechanism through which heart muscles are damaged is momentary constriction of blood vessels supplying the heart. However, further research needs to be done before conclusively supporting either of the potential causes for broken heart syndrome.
Physical stressors and causes of the condition, more often than not, are other medical conditions and disorders. Some of the physical stressors include, but are not limited to, stroke, seizures, breathing difficulties, surgery, high fever, significant blood loss, and low blood sugar levels. COVID-19 infection is also one of the causes of broken heart syndrome. Emotional causes of broken heart syndrome are grief, extreme sadness, surprise, and fear.
On rare occasions, certain medications can cause broken heart syndrome, specifically, emergency medications used to treat allergic reactions and severe asthma attacks. In addition, some of the anxiolytics and nasal decongestants can alter the heart's structure reversibly and result in stress cardiomyopathy. The use of illegal stimulant drugs such as cocaine also increases the risk of developing broken heart syndrome.
The signs and symptoms of broken heart syndrome are similar to the symptoms of a heart attack, hence, explaining why the former is often mistaken for the latter. Patients suffering from broken heart syndrome complain of sudden, severe chest pain and shortness of breath.
There is no standard treatment for broken heart syndrome. The treatment plan for the condition mainly focuses on heart muscle-strengthening medications to reverse the damage caused by the stress.
Some of the commonly prescribed medications for broken heart syndrome are:
- Angiotensin-converting enzyme (ACE) inhibitors
- Angiotensin II receptor blockers (ARBs)
- Blood thinners
The purpose of these medications is to reduce the stress on the heart and prevent further complications.
Broken heart syndrome, on its own, is not dangerous as all damage done is reversible. Moreover, when the cause of the syndrome is an emotional stressor, and appropriate medical intervention is applied, the overall prognosis is excellent. However, the prognosis of the condition worsens when it is caused by physical stressors such as stroke.
Suppose the damage to the heart is extensive. In that case, broken heart syndrome can be quite dangerous as it weakens the heart toward the following complications:
- Congestive heart failure
- Low blood pressure
With timely diagnosis and appropriate treatment, it is possible to treat these complications.
Broken heart syndrome develops suddenly and resolves quickly. Overall, broken heart syndrome lasts for approximately a month. However, frequent follow-ups need to be performed to ensure that the damage to the heart has reversed completely.
Heart attack is caused by the blockage of blood vessels that supply the heart, resulting in the death of certain parts of the heart. Damage caused by a heart attack is often permanent and results in scarring. In addition, heart function is permanently impaired after a heart attack. On the other hand, broken heart syndrome results in transient damage to the heart that can be reversed through medications.
Heart attack can be managed via medications, similar to those used for broken heart syndrome, or surgery, depending on the extent of the blockage. Unfortunately, surgical intervention does not provide any relief for symptoms of broken heart syndrome.
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- Mishra, Deepak Kumar et al. “Takatsubo cardiomyopathy: a case series of seven patients.” The Journal of the Association of Physicians of India vol. 61,12 (2013): 939-41.
- Amin, Hilman Zulkifli et al. “Takotsubo Cardiomyopathy: A Brief Review.” Journal of medicine and life vol. 13,1 (2020): 3-7. doi:10.25122/jml-2018-0067
- Syed, Asma Saba, and Umair Khalid. “Takotsubo cardiomyopathy vs acute myocardial infarction: diagnostic utility of subtle ECG differences.” International journal of emergency medicine vol. 4 17. 21 Apr. 2011, doi:10.1186/1865-1380-4-17
- Dawson, Dana K. “Acute stress-induced (takotsubo) cardiomyopathy.” Heart (British Cardiac Society) vol. 104,2 (2018): 96-102. doi:10.1136/heartjnl-2017-311579
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