Heart-felt Issue The Mysterious ‘Broken Heart Syndrome’ Is Real — and Preventable

“She died of a broken heart.”
That’s a phrase people say and hear often, usually in reference to an elderly woman, in apparently good health, who dies soon after the loss of a spouse or other loved one. When one uses the term, it is usually in a figurative context, but fairly recent research shows it can be applied literally.
Indeed, some women — although not many — actually die of what could be considered a broken heart.
Discovered just a few decades ago, and finally becoming recognized within the global medical community, is a condition that appears to be the result of tremendous stress. And the medical community calls it ‘broken heart syndrome,’ among many other, far more technical terms.
Its symptoms closely approximate a heart attack, or cardiomyopathy, said Dr. Amir Lotfi, medical director of the Davis Family Heart and Vascular Center at Baystate Medical Center and director of the Baystate Regional Myocardial Infarction Program, but this condition is something else altogether.
During a heart attack, Lotfi explained, the heart muscle is cut off from its supply of oxygen, either from a blockage or a spasm in one of the arteries that supplies blood. Broken heart syndrome, on the other hand, is thought to stem from a surge of adrenaline (hormones) that impairs the ability of the heart muscle in different areas to pump.
And this surge is thought to be caused by great stress, such as that which comes with the death of a spouse or loved one, but also from other life-changing developments, such as divorce or the loss of a job.
 “We don’t fully understand the mechanisms of the syndrome,” Lofti told HCN, “but it’s ‘called broken heart syndrome,’ or takotsubo cardiomyopathy, and frequently, but not all the time, it is related to some sort of great emotional or physical stress.”
Lotfi said accounts of the syndrome were first published in 1991 by Japanese doctors, who named it takotsubo cardiomyopathy after noting that the balloon shape of the affected heart, as it appeared on an X-ray, resembled a Japanese octopus trap called a takotsubo. But the syndrome has gained many names, including ‘stress-induced cardiomyopathy,’ ‘transient left ventricular apical ballooning syndrome,’ ‘apical ballooning syndrome,’ and ‘ampulla cardiomyopathy.’
What was initially thought to be just an issue in Japan soon became known worldwide in all ethnicities — with most victims being older women — as evidence showed the same signs and symptoms: an extremely stressful life event followed by chest pain and shortness of breath, irregular heartbeats, and, in the worst cases, cardiogenic shock, where the suddenly weakened heart couldn’t pump enough blood to meet the body’s needs — a situation that can be fatal if not treated right away.
Over the past five years, Lotfi has seen more than 25 patients with confirmed broken heart syndrome, which may seem like a small number, but the volume of confirmed cases is increasing because doctors are recognizing the symptoms more often. And because of the sheer number of Baby Boomers aging and experiencing stressful life events, more cases of this ailment are sure to be diagnosed, he added.
While this syndrome affects the heart, it appears to be a stress-related issue. But until fully diagnosed, physicians are treating cases as a possible life-endangering cardiomyopathy, all of which interests the AHA.
The organization is vigilantly following broken heart syndrome, because awareness of what it is, and why the medical community thinks it appears, can help those afflicted with it by encouraging them to reduce their stress. According to Mary Ann Burns, director of Communications for the Connecticut and Western Mass. chapters of the American Heart Assoc. and American Stroke Assoc., that’s just one part of preventing further heart disease in women (more on this later).
For this issue’s focus on women’s health, HCN talked with experts about brokem heart syndrome, which is still puzzling for physicians, those afflicted with it at the worst possible time of their lives, and those that work to make all women aware of heart disease in general.


In the Right Vein 
Lotfi told HCN that the description of the unusual syndrome discovered in Japan came after doctors noticed a number of women, usually post-menopausal, who were going to their doctors or being admitted with symptoms suggestive of heart attacks. But when EKG tests (electrocardiogram, an ultrasound of the electrical activity of the heart) were performed showing what looked like the heart muscle having an attack, the associated angiogram (cardiac catheterization in which a long, thin, flexible tube is put into a blood vessel and threaded to the heart) showed there were no significant blockages, which, as Lofti mentioned earlier, are typical of heart attacks.
When the wall-motion abnormality of the heart muscle that is erratically moving during the strange episode does not correlate with one single blood vessel as it would in true coronary disease, broken heart syndrome may be suspected.
Initial discovery of the condition was difficult because the use of clot-busting medications, which most cardiac patients are given upon signs of a heart attack, appeared to correct the situation immediately, when, in fact, the situation was not a real heart attack at all. Elaborating, Lotfi said that, because broken heart syndrome appears to be a heart-muscle issue, not a vessel issue, there is no blockage, so physicians assumed the clots had been dissolved by the time an angiogram was performed.
“It wasn’t until angiography became more prevalent that doctors saw this series of post-menopausal women having suggestive heart attacks, but the level of damage was disproportionate to the level of dysfunction of the heart muscle,” he went on. “And between one and four weeks, the heart function would go back to normal.”
“The population as a whole goes through excessive stress all the time, both physically and emotionally,” he continued. “But while the number of those with this syndrome is on the low side, people should still be aware of this and get it investigated.”
Once patients were presenting unusual EKGs but clear angiograms, investigation would lead to questions about recent stress involving a death in the family, loss of a job, divorce, or other upsetting health-related issues, which could be labeled as initiating factors, Lofti noted.
Currently, medical professionals feel that, of all post-menopausal women with heart-attack symptoms, 6{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 10{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} are broken heart syndrome. But while reoccurrence is low, at 3{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 8{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}, he added, it’s still not known why some patients have new episodes and others do not.
“But it’s so much in the forefront of knowledge and understanding now,” he said, “so once we can get you through the acute phase, you really do well, and your heart function recovers.”
At this time, broken heart syndrome has not been found to be a genetic condition like coronary disease or breast cancer, but where the advent of broken heart syndrome gets tricky is when it appears as a heart attack and adds to an already tremendously stressful situation. Finding out right away that chest pains are that of exacerbated stress, and not true coronary disease, can help calm the patient, as knowledge and support are keys to recovery.
After that, awareness of debilitating stress in the future can hopefully stave off another episode, and help to reduce overall stress for the patient in her lifetime, Lotfi added.
Stress Test
If there is a bright side to broken heart syndrome, it is that the condition is rarely fatal. But it is painful and quite scary, and this often leads to more awareness of heart disease overall — as well as steps to prevent it.
According to Burns, a decade ago, women of all ages thought heart disease was an old man’s issue, which was incorrect — and dangerous — thinking.
“It was found through research that women were really unaware that heart disease was the number-one killer of women,” Burns said. “Most believed that cancer was their number-one threat, when in fact, heart disease claims more lives than all forms of cancer, including breast cancer.”
At that point, the AHA knew there was a lot of work to do, and in 2004, the Go Red For Women campaign was launched. Over the past decade, physicians have been paying more attention to women’s heart health, asking them questions about their lifestyle choices that can lead to heart disease, and women across the nation have been paying more attention to their health, including the deeply stressful times that could lead to an episode of broken heart syndrome, Burns noted.
“Managing stress is a good idea for your overall health,” she said. “Exercise, maintaining a positive attitude, not smoking, and enjoying a healthy diet while maintaining a healthy weight are all positive steps toward reducing stress, and also help to reduce your risk for heart disease.”
To that end, the National Wear Red Day, staged by the organization Go Red for Women, encourages women to wear red to raise awareness of the ongoing fight against heart disease. The 10th annual National Wear Red Day will be staged Feb. 7. The day’s goals are two-fold: to raise awareness about heart disease in women and to raise funds for more awareness of programs and conferences, educational materials, and research.
Locally, the Western Mass. chapter of Go Red for Women will stage its annual luncheon on March 7 at the Log Cabin Banquet & Meeting House, and is looking to add $150,000 to the more than $575,000 raised during the past five years.
A major part of the annual luncheon is women sharing their stories, whether they involve surviving a heart attack, losing a loved one from coronary disease, or learning from others about mysterious ailments like broken heart syndrome, said Burns.
“The broad-brush stroke of heart-disease awareness gets them talking to their physicians,” she went on. “And it’s those conversations with their doctor that gets them to take steps, even small steps, that will ultimately modify their health.”

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