by Carolyn Thomas ♥ @HeartSisters
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 stress-induced cardiomyopathy or broken heart syndrome is a heart condition traditionally thought to be brought on by extremely stressful situations. This condition mimics a heart attack. It has long been considered by physicians as temporary and reversible, brought on by extremely stressful situations ranging from the death of a loved one to a severe asthma attack, a car accident or even major surgery.
But recent research reported in the New England Journal of Medicine suggests this cardiac event can follow physical exertion as well, but the condition has also been reported with no evident trigger at all. The study in fact described Taktsubo as “an acute heart failure syndrome with substantial morbidity and mortality”, adding: “Patients with Takotsubo cardiomyopathy had a higher prevalence of neurologic or psychiatric disorders than did those with an acute coronary syndrome.”
This cardiac event happens far more often in women, and is NOT a heart attack.(1) Heart attacks are generally caused by a complete or near complete blockage of a coronary artery due to a blood clot forming at the site of narrowing from fatty plaque buildup in the wall of the artery. But in broken heart syndrome, the heart arteries are not blocked, although blood flow in the arteries of the heart may be reduced.
Learn more about this condition here from Harvard University.
Heart Sisters 
Excellent piece; especially after I have witnessed this syndrome not once, but twice with loved ones. Years ago in the 80’s when an Uncle died of a heart attack, we got a second call the next day to hear that his wife [in her 60s] had abruptly died as well. It was sad to see the two coffins sitting at front of the memorial service and their only son was devastated after losing both parents within hours of one another. While this was not diagnosed as ‘broken heart syndrome’ back then, I have done enough subsequent research to know now that it certainly was.
Then, with a happier ending, it was more recently in 2008 that my dad’s 91 y/o wife was at the bowling alley when two bowlers were absent which meant that she felt compelled to keep the lanes moving [“hurry up, get back over here”]…and all of a sudden she turned pale white, began sweating and started to fall as a female friend quickly caught her before slumping to the floor. Initially, she remembered everything and knew the medics had “worked on” her both at the alley and in the ambulance. She almost flat lined twice when in the hospital for five days and when I stayed in the home for the next five weeks to watch over her and my 95 y/o dad, her recovery was anything but easy. The Cardiologist prescribed her a beta blocker at lowest dose while telling me this was the only drug [class] that could keep her adrenaline [epinephrine] lowered which, at the elevated level, was what had so adversely felt like a typical heart attack, even though the initial diagnostics did confirm she had no plaque in her arteries.
For a bit of history, this petite, elderly, post-menopausal woman had been the sole caregiver for my immobile dad [after firing in-home professionals] so she was tired to start with and two weeks prior to this life-threatening event, I later heard that a routine blood test had revealed hypocalcemia [low potassium, yet essential for heart] to which the doctor suggested she should “drink more orange juice.”
Furthermore, I had been in recently to visit the folks and with finite clues, I could see how she was dealing with non-diagnosed hypoglycemia [low blood sugar] since the early morning agitation was soon quelled by jam on toast plus the energy highs would suddenly plunge into a fatigue that would find her sound asleep by mid-day so I was already suspecting she was more compromised.
Anyway, once we got her through the adverse effects of that single drug, [took her off at end of one week with MD’s okay] this dear woman did improve physically, and by time of her three week check-up, the Cardiologist told us there were no signs of injury to her heart.
Unfortunately, with the imbalances of hormones [low glucose, heart-protective estrogen], her advanced age, and the instantaneous assault on her heart, not by one but a slew of stress hormones, there was increased memory loss in that first week home and now, three years later, she has no short term memory beyond the recall of same day activity. Needless to say, when the emotional, physical, mental and aging stresses are chronic enough to challenge the heart to the point of shutting it down, so can the brain suffer from short term or irreversible injury as well.
So, no matter the label; Taku-tsubo or Broken Heart syndrome or Stress-induced Cardiomyopathy, do trust they’re all the same. Take great care of your aging heart with plenty of rest, exercise, the safest foods and of course, all the kindness and patience you can possibly muster.
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Very interesting. Shows how sensitive we actually are, at a cellular level, to severe stress and shock.
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As a recently identified condition, it doesn’t mean we just invented it. We can only wonder how many patients have suffered this but were misdiagnosed for decades because standard cardiac tests didn’t pick up any coronary blockages.
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My mother was just diagnosed with this during a very stressful murder trial (her twin sister, my auntie, was killed) – at first we thought the cardiologist was kidding, who ever heard of broken heart syndrome? thanks to info like this on your website, many more people will now be aware that this can actually happen.
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