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Explaining broken heart syndrome

Main Line Health April 3, 2017 Heart Health

When Debbie Reynolds passed away just one day after the death of her daughter, Carrie Fisher, many of us wondered, “Is it possible to die of a broken heart?” Lankenau Heart Institute cardiologist Jeanine E. Romanelli, MD, faced that question from several of her patients. Her response? Yes, it is possible.

While Reynold’s cause of death was determined to be a stroke, there is indeed such a thing as broken heart syndrome, or as it’s more formally known, takotsubo cardiomyopathy. The condition is induced by extreme stress, which leads to a temporary disruption of the heart’s normal pumping function. The failure of the heart muscle is severe, but it’s typically short-term. With proper medical treatment, most patients experience a complete recovery within a few days or weeks.

“The exact cause of broken heart syndrome is not yet known, but researchers think that the body releases a surge of stress hormones that ‘stun’ the heart and affect its ability to pump blood to the body,” says Dr. Romanelli. “It’s triggered by an inordinate amount of emotional or physical stress, such as the death of a loved one, a break-up or divorce, a terrible fight with a child, a cancer diagnosis, or perhaps following major surgery. Patients go into acute heart failure, with symptoms mimicking those of a heart attack.”

Symptoms include sudden, intense chest pain and shortness of breath, and as such, the condition is often mistaken for a heart attack. In fact, tests show dramatic changes in rhythm and cardiac markers that are typical of a heart attack. But unlike a heart attack, there is no evidence of blocked heart arteries. The “stunning” effects of broken heart syndrome reverse quickly without any lasting damage to the heart.

“When a patient comes in to the ER with these symptoms, an ultrasound and bloodwork may indicate a heart attack,” explains Dr. Romanelli. “But these tests are not definitive. Any patient with worrisome test results needs to undergo a cardiac catheterization, where a thin, flexible tube is inserted through the blood vessels and into the heart to identify problems. If there are no signs of heart disease, blood clots or blockages, we’re able to diagnose broken heart syndrome.”

The condition can be life-threatening in some cases, but the good news is that most people make a full recovery. Treatment is similar to that for heart failure, including blood thinners, ACE inhibitors and beta blockers. An ongoing series of ultrasounds are then utilized to monitor a patient’s progress.

Broken heart syndrome was recognized fairly recently, first reported in the Asian population in 1990. It was named takotsubo cardiomyopathy, as the condition causes the heart to enlarge and assume a bulging shape that resembles the pot-like shape of a Japanese octopus trap, called a tako tsubo. Cases have since been reported worldwide, with the first reports of broken heart syndrome in the United States appearing in 1998.

Women, and more specifically, middle-aged women, are much more likely than men to experience broken heart syndrome. According to a recent study, women are seven to nine times more likely to suffer from this condition. Approximately 10 percent of people who have had broken heart syndrome will have a second episode at some point in their lifetime. There are no known forms of prevention.

Dr. Romanelli urges all of her patients to take any signs of a potential heart attack very seriously. “It’s critical to never ignore symptoms,” she says. “Women are especially prone to delaying medical attention so as not to be a bother or disrupt family activities. I tell my female patients, we’re no good to our families if we’re not here. A couple of hours spent checking if you’re okay is nothing compared to the lifetime your family would have to live without you. I say it over and over and over again. Don’t ignore your symptoms.”

If you or someone you know is experiencing the symptoms of a heart attack, seek help immediately by calling 911. Acting fast at the first sign of symptoms can save your life and limit damage to your heart.