A seemingly healthy woman, with no apparent risks or signs of heart disease, comes home from an afternoon with friends to find her husband has died in an automobile accident. Moments later, she is rushed to the hospital, clutching her chest, complaining of dizziness, and exhibiting other symptoms that resemble a heart attack.
An electrocardiogram shows some spikes in her heart’s electrical activity. But an angiogram, performed to identify arterial blockage, shows there is nothing restricting the flow of blood to or from her heart. No underpinning cause of heart trauma is determined.
This, reports her doctor, is curious.
medical director of
Tyler Heart Institute
For years, such curiosity went unsatisfied, says Dr. Richard Gray, Community Hospital's medical director of Tyler Heart Institute. Then, about five years ago, researchers gave it a name: stress cardiomyopathy. Many people simply call it “broken heart syndrome,” however, because it is set off not by heart disease but by the impact of a serious emotional event like the end of a relationship.
Researchers at Johns Hopkins University found that “sudden emotional stress can also result in severe heart muscle weakness,” Gray says. “It mimics a classic heart attack but is usually reversible.”
Patients are sometimes misdiagnosed with a massive heart attack when they have actually suffered from a surge in adrenalin and other stress hormones that temporarily “stun” the heart, he says. The symptoms begin to subside with medication and the leveling off of emotions and hormones. Recovery may take days or even weeks, but it is expected to be complete in most instances.
The condition is also called takotsubo syndrome, after the Japanese word for an octopus pot or trap, because the traumatized left ventricle expands, giving the heart a resemblance to this pot.
“When a patient comes into the hospital with symptoms resembling a heart attack,” Gray says, “this underscores the benefit of having an angiogram to determine whether or not it is an actual heart attack, and whether there is damage.
“We can prepare the patient for a rapid trip into the cath lab, where an angiogram will reveal whether or not there is a blockage. If not, we can reassure the patient and help him or her to relax. We can also administer medicine to calm the patient and support circulation. Once the bad feelings subside, so do the symptoms.”
The incidence of heart attack symptoms in such cases speaks to the considerable connection between heart and brain. And it almost always occurs among women.
“I’m resorting to poetic references here,” Gray says, “but women are more in tune to their emotional states. This syndrome appears to be an expression of the emotional impact of certain life experiences. And it’s not that rare: We see at least one of these a month at Community Hospital.
“Life’s uncertainties being what they are,” he continues, “it’s hard to cushion oneself against a ‘broken heart.’ But if you think you have signs of a heart attack, don’t wait; seek emergency medical help immediately. Let us diagnose and treat the symptoms of a heart attack or confirm the broken heart, which can correct itself over time.”
Warning signs of heart attack
• Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness, or pain.
• Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
• Shortness of breath, with or without chest discomfort.
• Other signs may include breaking out in a cold sweat, nausea, or lightheadedness.
• The signs above are experienced by men and women. In addition, women are more likely to experience nausea and back or jaw pain.
— American Heart Association