Broken Heart Syndrome

What do an octopus and your heart have in common? Well, sometimes they both can get stressed out. Dahhaha; ok not such a great punchline – but it is an interesting thing to think about. With the holidays coming up, I think most everyone is aware that it’s a tricky time to make healthy choices with all the sweets, and treats surrounding us. But all the festivities can also bring additional stress– with all the last minute shopping, countless potlucks you have to bring food for, and family tensions running high as everyone flies home. It’s a time of sharing happiness and love, but also it’s pretty darn hectic – and while we’re watching out for our waistlines, we need to also remember to look out for our heart in other ways too. So let’s learn a little bit more about this interesting phenomenon that can affect one of our most vital organs.  

What is it?

Takotsubo cardiomyopathy (also known as broken heart syndrome) is a stress-induced cardiomyopathy, named after the shape of the tako (octopus) traps used in Japan (where the syndrome was first identified in 1990). In this syndrome, the heart literally balloons out of shape at the apex (tip) of the heart, causing the heart to look strikingly similar to the round-bottomed, narrow-necked apparatus the Japanese use to catch octopi out in the open ocean. And it’s a serious thing  – the heart is not pumping blood as effectively as it normally does, and this condition can lead to acute heart failure, rupture of the ventricles within your heart and lethal ventricular arrhythmia. Luckily, this syndrome resolves quickly (within 1-10 weeks) with complete restoration of ventricular function.

What causes this?

It is not entirely understood how this syndrome occurs, but we do know that it occurs in about 1-2% of patient who present with acute coronary syndrome (for example – in the ER with chest pain symptoms) that is troponin –positive. Troponin is a marker of damage to cardiac cells, and one of the indicators that we often use to diagnose a heart attack.

Women are much more commonly affected than males, and this syndrome occurs most commonly in the elderly population. In a study done in 26 centers throughout the US and Europe, the mean age at presentation was 66 years old, and nearly 90% of the individuals identified with the syndrome were women. Post-menopausal women are at the highest risk for Takotsubo syndrome.

Physical or emotional stress are the main triggers for this condition – hence the alternate name- stress-induced cardiomyopathy. Examples of these types of stressors are listed below.

  • Emotional stressors: grief from the death of a loved one, arguments with family members, financial problems, betrayal, fear of public speaking, winning the lottery or sports competition, a wedding or a reunion etc.
  • Physical stressors: asthma attack, surgery, chemotherapy and stroke etc.

So, basically, anything that can be considered “stress” in your life, can be a trigger for this condition – even happy events.

There are some other theories continuing to be researched out there about catecholamine storm, coronary artery vasopasm, and microvascular dysfunction, but suffice to say, it’s clear that there is a correlation between stressful events and this abnormality in the heart function and form.

How is this different from a heart attack?

One of the key differences is that this is a transient condition- meaning that it only occurs for a short period of time, and most often there is total resolution of abnormalities within the heart. Also important, is the fact that there is no obstructive coronary artery disease or any evidence of an acute atherosclerotic plaque rupture on angiography (the study where they shoot dye through the arteries of the heart). So basically, this is not caused by cholesterol build-up in the heart, blocking your coronary arteries.

Takotsubo syndrome presents clinically in a very similar way to a heart attack – with acute chest pain, shortness of breath, and fainting.  EKG changes also look similar to a heart attack (ST elevation and depression being the most common) and some individuals may progress to cardiogenic shock, and dangerous heart rhythm abnormalities (ventricular tachycardia, ventricular fibrillation, bradyarrythmias, and sudden cardiac arrest).

How do you treat this?

When acutely presenting with the symptoms mentioned above, because this syndrome looks so similar to a heart attack, individuals are taken to the cardiac catherization lab, to do coronary artery interventions. When heart attack is ruled out, then the diagnosis can be made (the really dangerous stuff needs to be excluded first – including myocarditis, and pheochromocytoma).

Treatment for this syndrome mainly involves supportive care, as this is something that resolves with time on its own in most cases. In the acute phase, patient are treated with the same medications used in CHF (chronic heart failure) – beta blockers, ACE inhibitors, and diuretics as needed. The risk of recurrence of this syndrome is very low (less than 2%) and this syndrome does not significantly increase your risk of coronary artery disease (heart attack, stroke etc), so in the long-run the main treatment is to reduce stressors in one’s life.

What should I take away from this?

We are very conscious of heart health in terms of exercise, and diet – and while these things are certainly important to keep your ticker in the best shape possible, we often forget that stress is a serious contributor in regards to our health. Takotsubo syndrome is a serious medical condition and indeed it is a physical change that is seen in the literal shape of one’s heart – and is ultimately caused by stress.  So, now you can tell all your friends – I know the cure for a broken heart – it’s simple, just no stress! And maybe go pick yourself up some tako poke! =p

Written by Joy Piotrowski, MS3