When Margaret a 65 year old woman suffered a "heart-attack" like episode, her family and were friends were baffled. She had no history of heart disease and was a health and fitness enthusiast. She never smoked, never took pills, and had been a generally "happy" person until now. Sudden chest pain and shortness of breath, brought her to the city hospital's emergency department. After a battery of tests, she was diagnosed with a "broken heart" syndrome. Her attending cardiologist said it was brought on by her husband's untimely demise from a fatal car accident.
Margaret's experience is not rare. The disorder was first noted by Japanese researchers fifteen years ago and was named "Takotsubo" Cardiomypathy. The illness was named after an octopus "tako" trap "tsubo" as the swollen heart resembled the item. (The lower left ventricle of the heart "baloons" at the apex- the pointed portion of the heart).
What Happens to the Heart During a Severe Episode
According to Dr. Wittstein, a leading cardiologist at the John Hopkins Medical Center, many women have suffered this disorder, but physicians didn't recognize it. In a study conducted by the Hopkins team, they found that unforeseen overpowering emotional distress can induce the release of large amounts of stress hormones that temporarily "stuns" the heart. The hormones: adrenalin (epinephrine), noradrenalin (norephinephrine) and proteins neuropeptide y, brain natriuretic peptide, and serotonin are secreted by an excited nervous system producing symptoms that resembles a typical heart attack. They include chest pain, fluid in the lungs, shortness of breath, and heart failure - a condition in which the quantity of blood pumped by the heart is insufficient to meet the body's normal requirements.
They also observed that unlike patients who have suffered a "classic" heart attack, these women were previously healthy and had no risks for heart disease. Angiograms (a test that makes blood vessels visible on X-ray films by injecting into them a radio-opaque substance) showed no blockages in the arteries that supply the heart. Blood tests showed no signs of highly elevated levels of cardiac enzymes, substances released into the blood from damaged heart muscle(s). Magnetic Resonance Imaging (MRI) showed none of the patients had suffered irreversible muscle damage. They also recovered within a few days, and achieved complete recovery after two weeks. By comparison, those who suffered typical heart attacks - Killip Class II or III Myorcardial Infarcation - can take weeks or months recovering. Their heart muscles are often permanently damaged.
More Clues
In the base of the heart's main pumping chamber, where the left ventricle contracted normally, there was weakened contraction in the middle and upper portions of the muscle. The investigators believe that the chemicals caused spasm in the arteries, or caused calcium overloads that resulted in temporary dysfunction of the organ. They also suspect that some of the patients have a genetic vulnerability for the disorder. The women were treated with standard protocol for acute coronary syndrome: aspirin, anticoagulants, beta-blockers. All had excellent recoveries of their respective left ventricular function. The study was published in the February 2005 issue of the New England Journal of Medicine.
More recently between July 2004 and April 2008, Dr. Richard Regnante M.D. a cardiologist and teaching fellow(Warren Alpert Medical School, Brown University) and his colleagues created a registry of 70 patients with Broken Heart Syndrome. Their review showed that 2/3rds of the subjects were nearly all menopausal women who had experienced stressful physical or emotional distress before hospital admission. The investigation also showed that unlike the classic heart attacks that generally occurs during winter months, these cardiomyopathies occurred during the spring and summer months. A new study is underway using intravascular ultrasound (IVUS). This imaging device can show ruptured plaque(s) in the artery or a small blood clot which happens when a patient suffers from a heart attack. This outcome cannot be seen well on angiography alone. Their findings were published in the 2009 issue of the American Journal of Cardiology.
The causes of the Broken Heart Syndrome are not yet fully uncovered. Much has yet to be discovered. The good news is it is better understood and recognized today, and more investigations are underway to determine the best treatments and preventive measures.
References
Wittstein IS et al. "Neurohormonal Features of Myocardial Stunning Due to Sudden Emotional Stress" New England J Medicine Feb.10 2005;352:539-548
Regnante RA et al. "Clinical characteristics and 4-year outcomes of patients in the Rhode Island Takostsubo cardiomyopathy" American J Cardiology 2009;103:1015-1019
Derrick Dawn "The Broken Heart Syndrome: Understanding Takotsubo Cardiomyopathy"Critical Care Nurse 2009:29:49-57
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