Broken heart syndrome

by SARAH JOHN

Special Arrangement Sudden shock: More women fall victim to the broken heart.
It has symptoms similar to a heart attack but the main cause is sudden shock or stress.

The broken heart is a serious topic not just in novels and films, but also in the not-so-romantic medical field of Cardiology. The “symptoms” are sudden acute pain in the chest, in the neck and left arm, accompanied by breathlessness, nausea and/or vomiting; similar to the symptoms of acute myocardial infarction or Heart Attack. At this point, it ceases to be romantically exciting and the situation demands a totally different type of attention.

A typical case involves a female patient around 50+ years, who is brought to the Emergency Room of a hospital. The ECG and ultrasound scan show that the left ventricle is practically non-functional. But there is no block in the coronary arteries and no stoppage/reduction of circulation to the heart muscles. No valve lesions and no circulatory interruption, but the muscles of the left ventricle ceased to function as though paralysed. Why? The heart is “broken”! This patient reacted to the sudden break up of her marriage.

Cause

Takotsubo Cardiomyopathy is the medical term for the condition described above. Since the beginning of the 1990s, it is also known as “Broken Heart Syndrome”. It is the shape created by the “apical ballooning” or the bulging out of the apex of the heart with preserved function of the base that earned the syndrome its name “tako tsubo” or octopus-trap in Japan, where it was first described. The cause for this heart-attack like illness is usually acute stress or an extreme shock, which could be negative as in the case above or positive like a lottery win.

It has been observed that women's hearts “break” more often than those of men. The New England Journal of Medicine reported the study of a series of such cases and came to the conclusion that more than 90 per cent of the patients were women between the ages of 50 and 70 years. Some cardiologists believe that the reduction in oestrogen levels in women after menopause could lead to the activation of the autonomous nervous system. This could result in the production of too much stress-hormone, which in turn may have a negative effect on the heart muscles. There are nonspecific changes in the electrocardiogram and some elevation of cardiac enzymes (Troponin and Creatine kinaso) in blood.

Treatment

The patient needs to be kept under close observation, usually in the Intensive Care Unit, for any further sign of shock-symptoms. What is critical is that the attending physician recognises the symptoms of the “fake-attack” and does not start the patient on medication meant for heart attack. This could lead to deleterious consequences.

The patient is advised bed-rest in quiet, calm surroundings away from excitement and stress. The dysfunction of the left-heart muscles disappear normally within days or weeks. Unlike in the case of a real heart-attack, no permanent damage is left over on the heart muscle. Most patients survive the initial acute presentation of the so-called Broken Heart Syndrome, with very low rate of mortality or complication. Direct preventive measures are difficult because shock and stress are not easily preventable.