After the first attack of severe chest pain, the 61-year old woman spent the night in the hospital’s Emergency Department hooked up to a heart monitor, felt better after a few hours, and was discharged in the morning. Even though she had no cardiac risk factors, her blood tests showed that her cardiac enzymes were somewhat elevated, she described a “too-much-adrenaline” feeling, and she had also failed a cardiac treadmill stress test because of heart rate arrythmias. No positive diagnosis was made at the time, although a condition called myocarditis was suggested.
Then nine uneventful years later, a second attack occurred, this one during a very traumatic period in her life, in hospital for a colon resection operation due to cancer. She describes it like this:
“This second attack happened just five days after I underwent my cancer surgery and was still in hospital. It felt to me like a repeat of the first ‘fake heart attack’, and I argued with my internist to this effect.
“At some time on the second day, the T-wave on my EKG had become inverted, and subsequently this became more so. My cardiac enzymes (CK and troponin) were up.
“An echocardiogram two days after the event was reported as a recent LV infarct, and angiogram on the third day showed anteroapical hypokinesis. So I gave in and finally accepted the diagnosis of Takotsubo cardiomyopathy!”
Takotsubo cardiomyopathy or broken heart syndrome is a temporary heart condition usually thought to be brought on by extremely stressful situations.
First described medically in 1991 by Japanese doctors, the condition was originally called Takotsubo cardiomyopathy after a type of pot used by Japanese octopus fishermen. When doctors take x-ray images of a person who’s experiencing broken heart syndrome, part of his or her heart resembles this pot.
Physical stressors such as the death of a loved one, severe asthma attack, car accident or even major surgery have been known to trigger broken heart syndrome.
According to Mayo Clinic cardiologists, the condition is also referred to as stress cardiomyopathy, stress-induced cardiomyopathy or apical ballooning syndrome.
Broken heart syndrome is not a heart attack, but it can mimic one, with common symptoms being chest pain and shortness of breath. The prognosis is usually excellent, and recurrence occurs in fewer than 10% of patients.
Most heart attacks are caused by a blockage of a coronary artery due to a blood clot forming at the site of a plaque rupture. In broken heart syndrome, the arteries are not blocked, although blood flow in coronary arteries may be reduced.
The good news is that broken heart syndrome is treatable and usually requires about a week to recover. While there are no standard treatment guidelines for treating the condition, doctors will likely prescribe blood pressure medications while in the hospital. These medications help reduce the workload on the heart during recovery.
Rarely, in about 5% of cases, untreated Takotsubo can lead to transient but severe, even lethal, cardiogenic shock.
Procedures that are often used to treat a heart attack, such as bypass surgery, coronary angioplasty or stent implants, are not helpful in treating broken heart syndrome. These procedures treat blocked arteries, which are not the cause of broken heart syndrome.
Rhode Island researchers last year made two interesting observations about the patients with broken heart syndrome that they had studied:
- the majority of broken heart syndrome cases occurred in post-menopausal women
- most cases occurred during the spring and summer months
“Some believe it is simply a form of a heart attack that ‘aborts’ itself early and therefore doesn’t leave any permanent heart muscle damage. Others say that the syndrome has nothing to do with the coronary arteries and is simply a problem with the heart muscle.”
If you’re having any chest pain or shortness of breath after a stressful event, seek emergency medical assistance immediately.
♥ NEWS UPDATE: July 20, 2011:
New research* out of Germany published in the July 20 issue of the Journal of the American Medical Association suggests that a stressful trigger to the onset of Takotsubo or stress cardiomyopathy could be identified in only 71% of patients.
Stress cardiomyopathy is known to be associated with a distinctive left ventricular (LV) contraction patterns, but its symptoms are often mistaken for acute coronary syndrome. In fact, in this study, 88% of patients reported symptoms consistent with acute coronary syndrome.
A total of 87% of patients had abnormal ECGs at presentation. Cardiac enzyme (troponin) blood levels were typically only mildly increased (90%). But there was no relation between ballooning patterns and troponin levels or clinical features such as age, sex, and stress trigger.
One of the hallmarks of stress cardiomyopathy is the absence of coronary artery disease. In this study population, 75% had healthy coronaries, while 6% had a stenosis (blockage) of 75% or greater that did not correspond to the area of wall motion abnormality. The remaining patients had only mild coronary disease.
* Eitel I, et al “Clinical characteristics and magnetic resonance findings in stress (Takotsubo) cardiomyopathy” JAMA 2011; 306(3): 277-286.