HeartBeats

Broken Heart Syndrome

9fb40af7321189572ca3_images-2.jpeg
9fb40af7321189572ca3_images-2.jpeg

Can a heart truly be broken? Unfortunately many people have suffered the emotional aspects of a broken heart, but can the heart be physically broken as well? Consider the following scenario. A 67-year-old woman presents to the emergency room (ER) with chest pain.  She lives alone and earlier in the day she learned that her faithful companion, her dog, passed away.  In the ER, she is found to have a very abnormal electrocardiogram (EKG) and her blood enzymes are suspicious for a heart attack.  She is admitted to the hospital and undergoes a heart catherization the next day. Her cath reveals normal heart arteries, without evidence for blockage, but her heart is severely damaged. What is happening?

She is suffering from a condition known by various colorful names including broken heart syndrome, apical ballooning syndrome, and stress-induced cardiomyopathy (cardiomyopathy is a weakened or damaged heart muscle).  This condition was first described in Japan in 1991. The Japanese coined the condition Takotsubo cardiomyopathy because the heart muscle resembles a Japanese octopus trap with a narrow neck and a wide base.  Stress-induced cardiomyopathy occurs primarily in women (90 percent), the majority of whom are post-menopausal. It is often associated with a chronic psychiatric disorder such as anxiety or depression.  It is commonly triggered by an emotional event. Stressors include learning of the death of a loved one, public speaking, a surprise birthday party, a lightning strike, or an earthquake. Physical triggers, such as pain or anxiety over a medical procedure can provoke an event as well.  In women, an emotional trigger is more likely, while a physical stressor is more common in men. The vast majority of patients present with chest pain and EKG changes; their presentation often looks like an acute heart attack. In addition, there are high levels of cardiac enzymes in the blood. These enzymes are typically released when the heart is damaged, as occurs with a heart attack. Heart catherization often shows no blockage in the heart arteries but the heart muscle is severely damaged and not contracting. The most common area of damage is the apex or the tip of the heart. Due to this damage, the heart’s pumping capacity, the ejection fraction, is significantly reduced.  Patients are treated with beta-blockers to reduce the effect of adrenaline (catecholamine) on the heart and ACE inhibitors to prevent congestive heart failure from the low ejection fraction. While death and stroke can occur with stress-induced cardiomyopathy, the vast majority recover.  Fortunately, the heart function also usually recovers and returns to normal after several days to several weeks. The prognosis is usually good, although about 10 percent of patients have a recurrent event, despite treatment.

The exact cause of stress-induced cardiomyopathy is not known. There are many possible explanations but the prevailing theory is that a trigger provokes a “fight or flight response” resulting in a rush of stress hormones (adrenaline, catecholamines) and an exaggerated stimulation of the nervous system. It is well known that adrenaline and nervous system stimulation can cause severe damage to the heart.  The brain is the common factor. Adrenaline is released on command from a part of the brain (the pituitary gland) and the nervous system is activated in the brain. Stress-induced cardiomyopathy is felt to be part of a number of syndromes with a brain-heart connection. For example, patients with an acute stroke or a bleed in the brain often have EKG changes similar to those seen with stress-induced cardiomyopathy. Activation of the “fight or flight” response can also cause irritability of the heart leading to arrhythmias and potentially sudden cardiac death. In fact, the brain-heart axis may contribute to deaths associated with primarily neurologic conditions such as stroke, seizure disorders and head trauma.

For this upcoming Valentine’s Day, let’s keep both the heart and the brain healthy and hope that there are no broken hearts out there.

Bridgewater resident Steve Georgeson is a cardiologist who works for Medicor Cardiology. Here, he writes about topics and events pertaining to cardiology

The opinions expressed herein are the writer's alone, and do not reflect the opinions of TAPinto.net or anyone who works for TAPinto.net. TAPinto.net is not responsible for the accuracy of any of the information supplied by the writer.

TAP Into Another Town's News:

You May Also Be Interested In

Sign Up for E-News

Bridgewater/Raritan

Bridgewater Police Investigating Theft of Children's Miracle Network Donation Bin, According to Report

May 25, 2018

BRIDGEWATER, NJ - Bridgewater Township Police are investigating a report of a theft of a Children's Miracle Network donation bin from convenience store on Route 22 May 21, according to a report.

According to the report, a Speedway employee reported that someone stole the bin from the counter inside the store. The collection bin, the report said, contained an unknown amount of ...

Jacobus Vanderveer House Designated A Blue Star Museum

May 20, 2018

BEDMINSTER, NJ - Bedminster’s historic Jacbous Vanderveer House & Museum has been designated a Blue Star Museum, one of more than 2,000 museums across America to offer free admission to the nation’s active duty military personnel and their families from Memorial Day through Labor Day.  The Jacobus Vanderveer House & Museum is one of 24 Blue Star Museums in New ...

Somerville Suspect Charged with Armed Robbery of Gaston Avenue Store

May 25, 2018

SOMERVILLE, NJ – A 22-year-old borough resident has been charged with armed robbery at a convenience store on Gaston Avenue, accoeding to Somerset County Prosecutor Michael H. Robertson..

Jake Sommers, 22, of Eastern Avenue is lodged in the Somerset County Jail and faces charges of first degree robbery and third degree possession of a weapon for an unlawful purpose.

Robertson provided ...

'Turning Off the Morning News' brings comic twist

‘Turning Off the Morning News’ tackles today’s issues with a comic twist

By Liz Keill

PRINCETON, N J – Despite the late night comics, no one quite captures the insanity of the political/social status world like Christopher Durang.

His latest play, “Turning off the Morning News” hit the ground running.  John Pankow as Jimmy addresses the audience, ...

'To Kill a Mockingbird' Sustains Timeless Appeal

SUMMIT, NJ – The Summit Playhouse provides a stellar production of a much loved classic, “To Kill a Mockingbird.”

The Harper Lee novel, later a Gregory Peck film and now a stage production, retains all the warmth, intensity and integrity that made it such an appealing hit in the 1960s. And there will be a new production on Broadway in December with a script by Aaron Sorkin ...

To Borrow or Not to Borrow?

If you are like me, you have debt. Whether it’s your mortgage, student loans, or credit cards – or all of the above – most people carry debt. It helps us pay off important but high cost expenses over time and makes them affordable and it helps us through difficult times when perhaps our cash flow isn’t what we need it to be. However, sometimes it just feels ...

The (Wrong) Advice Your Doctor Gave You

It's all too often that a patient comes to my clinic afraid to squat because their Doctor had told them "it's bad for your knees."

Patients seem confused when I smile back and ask, "How did you just sit down and stand up out of that chair if you aren't able to squat?"

You see, advice like this is handed out all too often, and I'm on a mission to have ...

Vehicular Homicide Charges for Driver of Paramus School Bus

May 24, 2018

MORRISTOWN, NJ - The driver of a school bus involved in a crash on Route 80 last week that killed two people faces two counts of second-degree vehicular homicide/death by auto, it was announced today.

The driver, Hudy Muldrow, 77, of Woodland Park, attempted to make an illegal U-Turn on the highway in an attempt to find his way to Waterloo Village, the planned destination of the bus that was ...