Dr. Aaron Ford, a board-certified cardiologist on the medical staffs at Coastal Carolina Hospital and Hilton Head Hospital, discusses broken heart syndrome and cardiac health.
Question: I read something recently about broken heart syndrome and heart health. Is this a real phenomenon and if so, how are they connected?
Answer: It may be hard to believe but the symptoms and test results of broken heart syndrome are similar to those seen with a heart attack. There are many names for this condition: apical ballooning syndrome, takotsubo cardiomyopathy, and stress-induced cardiomyopathy, and the effect that this condition has on the heart is serious.
The test results, including the EKG and blood tests, are very similar to that of a heart attack, but there is no evidence of blocked arteries or other causes of a heart attack to explain the symptoms.
The condition was first described in Japan in 1990. In Japan it is called takotsubo syndrome because in this condition the heart looks like the Japanese name for an octopus trap! Studies estimate that of the people admitted with evidence of a heart attack, 1-2 percent of those cases are actually from the broken heart syndrome. The International Takotsubo Registry states that patients with this condition tend to be women; the mean age is 66 years old.
Nobody quite knows for sure what causes this condition, but stress is thought to play a major role. Many (but not all) patients with this condition have some type of significant physical or emotional stress prior to the onset of symptoms.
Because of this association, the thought is that very high levels of adrenaline (our “fight or flight” hormone) are released in response to a stressful situation, and that this release of adrenaline is responsible for the damage to the heart muscle.
Several studies have shown that in people with the broken heart syndrome, blood levels of adrenaline are much higher than those with a typical heart attack from blocked arteries. However, not all studies show this strong association, so there remains some controversy in this area and the condition is not yet entirely understood.
Patients who have this syndrome present in a very similar manner to an individual having a heart attack. Blood tests and the EKG (the heart tracing showing the electrical activity of the heart) will point to a heart attack, but the main feature when a cardiac catheterization, in which a catheter is run through an artery in the leg or wrist to the heart to inject dye into the arteries, is subsequently performed is the absence of a blockage in a blood vessel to explain the symptoms.
The heart muscle is also weakened and the tip of the heart doesn’t contract correctly. An ultrasound of the heart, also known as an echocardiogram, will show this decrease in contraction at the tip, or apex, of the heart, as well as the cardiac catheterization.
The treatment for this condition is very similar to that of a heart attack where the heart muscle is damaged, with most patients requiring supportive medical care and a regimen of medications to optimize the performance of the heart muscle.
Patients will initially be treated in the hospital, but the majority of patients will recover with the heart function returning to normal, usually fairly quickly (one to four weeks according the takotsubo registry).
Few will suffer significant complications. There have been no studies on how long patients should be treated.
In my practice, Hilton Head Heart, I generally will continue treatment even after the heart has returned to its healthy pumping capacity in order to prevent symptoms from recurring as long as there are minimal side effects of the medications, but technically the optimum duration of therapy is unknown.
This is not a condition to be taken lightly. If you feel you may be suffering from these symptoms, without significant testing there is no way to know if it is a traditional heart attack or the broken heart syndrome, so you need to get the emergency room ASAP. This can be a very serious condition, but with the right diagnosis and treatment, most will recover fully.