By Steven Ross Johnson, Special to the Tribune
February 22, 2012
For centuries, there have been songs, writings and proclamations about losing love, with many often using the term "a broken heart" to describe the pain.
But it appears there is medical truth to the notion that a traumatic emotional experience can lead to a severe cardiac condition, which can initially display all of the signs associated with those seen in a heart attack.
"A lot of these patients would come in with chest pains and difficulty breathing into the emergency room. We found out that they actually were not having a heart attack, but their hearts were weak for some reason," said Dr. Binh An P. Phan, a cardiologist at Loyola University Health System. "We found out that it was related to a very emotional experience that they were having that immediately preceded the episode."
The condition, commonly called broken heart syndrome, is known in the medical profession as stress cardiomyopathy, which can cause a temporary weakening of the heart muscle brought on by intensely stressful situations, such as the loss of a loved one.
"After the emotional experience passed and we followed up on them after a few weeks, their heart function returned to normal," Phan said. "We still don't know exactly the mechanism as to how a stressful situation can trigger a weak heart."
Most experts believe the cause has to do with a surge of stress hormones, such as adrenaline, to the heart during a stressful event, which in turn narrows the arteries that supply blood to the organ, Phan said.
Though the experience can feel similar to a heart attack, there are considerable differences between the two conditions, said Dr. Ilan Wittstein, assistant professor of medicine at Johns Hopkins Hospital in Baltimore.
"With a heart attack, there is permanent damage done to heart muscle. Some of the heart muscle dies when blood can't get to it, and once that tissue is dead, it's never going to be alive again," Wittstein said. "With broken heart syndrome, patients come in with heart muscles that look extremely weak. They're not pumping blood well at all, but the cells of the heart are still quite alive. The heart muscle over the course of a few days to a couple of weeks usually completely recovers."
Discovered in Japan in the early 1990s, broken heart syndrome was originally called takotsubo syndrome, because physicians there noticed the heart enlarged and took the shape of a takotsubo — a fishing pot used to trap octopus — when the condition occurred. The condition became known as stress cardiomyopathy in 2006 when researchers at Johns Hopkins published one of the first studies about the condition in the U.S.
Wittstein estimated about 1 percent, or 10,000, of the 1 million reported cases of congestive heart failure that occur annually in the U.S. actually experience broken heart syndrome. It is not known how many people die from the condition.
Another crucial difference between those diagnosed with broken heart syndrome and those who experience a heart attack is in the rate of recurrence of another episode.
According to theU.S. Centers for Disease Control and Prevention, each year 60 percent of those who have experienced a heart attack experience a second one, while a second episode of broken heart syndrome occurs in only 10 percent of those who have been affected.
Unlike the numbers found among those affected by coronary heart disease — more than half are men — the vast majority of those diagnosed with broken heart syndrome tend to be post-menopausal women, who make up about 90 percent of all reported cases.
"I think that this is one of those diseases that clearly points to the fact that there is a connection between emotions and physical health," said Dr. Annabelle Volgman, medical director of Rush University Medical Center's Heart Center for Women. "When these women come to the emergency room, they shouldn't just be told they have a lot of stress in their life and take some Xanax and go home. I think these women really need to be evaluated for something potentially devastating."
One theory about the large disparity in the numbers between women and men, Wittstein said, concerns the same factors that seem to protect women from heart disease earlier in life.
"Estrogen seems to do a lot of important things for the heart, including improve how the blood flows to the heart and how the heart may be protected against stress hormones," Wittstein said. "As women age, and as their estrogen levels come down, they now don't have that same protective mechanism that they had when they were younger."
Other risk factors include those with histories of anxiety or depression, as well as those who Wittstein said may be genetically predisposed to the condition.
Preventive measures people can take to lower their risk of experiencing broken heart syndrome include eating a proper diet and exercising regularly as well as, when possible, reducing the number of factors that consistently cause stress, such as quarrels with family or stressful work situations.
Whether a person believes he or she is having heart attack or experiencing a case of broken heart syndrome, Wittstein stressed the importance of seeking medical attention immediately when an attack occurs because each can be fatal without proper care.
"When people say can you die from a broken heart, the answer is absolutely yes," Wittstein said.
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