An In-Depth Look at the Phenomenon Called Broken Heart Syndrome

The Myocardial Stunning Hypothesis and Its Evolution

In the year 1971, a report with 170 cases of sudden cardiac death was published, and sympathetic activation played a prominent role in almost all cases. This implied that all the cases were dealing with intense stress, resulting from extreme anxiety or worry, prior to their eventual death.

Later in 1980, Hirsch and Cebelin illustrated described a series of death, which was followed by physical assault in which there was no internal injury in the post-mortem examination. Their study was the conclusion of 30-years research in Cuyahoga County, Ohio. The duo reported that the condition of myocardium displayed contraction between myofibrillar degeneration and band necrosis.

This was similar to what animals go through in situations of extreme stress and was linked to a high level of catecholamines. Based on this, they suggested that the stress caused a rise in catecholamine levels to generate lethal myofibrillar degeneration in humans.

The Japanese scientists who were initially involved described it as the occurrence of the hypokinetic segment in the heart that extends from the center of the heart to the mid-portion of the left ventricle. Their observation states that during this situation, the heart takes an end-systolic appearance that resembles a wide-mouthed and bellied pot that has a narrow neck similar to the octopus trap. This is where the name Takotsubo Cardiomyopathy came from in this scenario.

How Relevant is Broken Heart Syndrome?

In broken heart syndrome, stress can put a strain on the heart muscles, resulting in the occurrence of symptoms that resembles a heart attack. This condition is most common in older women who have suffered from major physical or mental strain. Studies also suggested that this syndrome can also occur in men and premenopausal women.

Over the years, many studies were conducted where the patient’s age varied between 30 to 90, and the average was 69. 81% of the affected patients were postmenopausal women, 8% were younger women below 50, and 11% were men.

For around 30% of the patients, the cause was emotional that included the death of loved ones, anxiety, interpersonal conflict, job loss, anger, 41% of the patients suffered this syndrome due to physical cause including asthma, COPD, chemotherapy, bronchitis, and other health ailments. For the rest of the people, the cause remained unidentifiable.

What Are the Causes of Behind Broken Heart Syndrome?

Sudden and extreme physical and emotional stress can trigger a series of events that result can result in acute systolic heart failure. This occurs in a characteristic regional wall motion pattern that case serious hypokinesis of the mind as well as apical myocardial segments along with with the blockage the basal segments, resulting in the apical ballooning of the left ventricle.

The pathophysiology that contributes to this symptom is still unclear; however, it does cause a sudden catecholamine surge. A similar acute left ventricular dysfunction pattern was seen in cocaine intoxication. The challenging part about the clinical diagnosis of stress-associated cardiomyopathy is the similarity between the symptoms between broken heart syndrome and acute coronary syndrome. For instance, chest pain, weakness, shortness of breath, hypertension, palpitations, diaphoresis, and nausea are common symptoms of both cases.

Doctors believe that stress hormone plays a prominent role in this condition. The body releases an increased amount of stress hormone in response to particular stimuli. Another theory can damage the heart and impact its functionality.

Generally, broken heart syndrome is followed by an intense trigger. Some of the events that can cause serious ailments include the following:

• Loss of a job – If you have recently lost your job and you have no financial back-up, it can create much stress in your life. Furthermore, if you are always trying to land a new job and you are not getting any, then that can also create acute stress.
• Death of loved ones – If you have recently lost your loved ones, that can also create a stressful situation for you.
• Domestic abuse- if you are a victim of domestic violence, and there is no one to support you, then this is also a severe cause of stress.
• Break up – parting ways from your romantic partner is also a reason that can cause acute stress.
• Divorce- parting away from your spouse is another reason that can trigger extreme stress.
• Frightening medical diagnosis – If you have recently been diagnosed with a severe medical condition that can also create stressful situations.
• Public performance
• The loss or gain of a considerable amount of money

Physical stressors, including car accidents, surgeries, injuries, asthma, can also trigger broken heart syndrome. Moreover, certain medications or drugs can cause broken heart syndrome when they increase the release of stress hormones in the body. Medicines that treat asthma attacks or allergic reactions often contain adrenaline in large quantities.

Some antidepressants can also cause such symptoms. Medications given to patients with thyroid issues include a hormone that stimulates metabolism, resulting in broken heart syndrome.

Prominent Symptoms of Broken Heart Syndrome

Symptoms of broken heart syndrome can occur within minutes or hours post the stressful situation and somewhat similar to a heart attack. When people experience such symptoms, they should seek immediate emergency cases as there is no way to distinguish between both the illness without proper testing and diagnosis by the doctor. Following are the common symptoms an individual experience when dealing with broken heart syndrome:

Angina

Angina is discomfort or chest pain that is caused when the heart muscle is not able to get adequate oxygen-enriched blood. It might feel like your heart muscles are being squeezed. This discomfort can also be felt in your shoulders, neck, jaw, arms, or back.

Angina pain might even feel like you are suffering indigestion. It is not a disease, but a severe symptom of an underlying heart condition. It is typically a symptom of coronary heart disease; it could also be a sign of a broken heart; therefore, it is essential to get immediate treatment. There are different types of angina, including microvascular angina, stable angina, unstable angina, Prinzmetal’s angina, and variant angina.

Shortness of Breath

Not being able to get an adequate amount of oxygen is one of the frightening sensations that one can feel. Shortness of breath is medically known as dyspnea. It is often described as a sharp tightening in the chest, difficulty in breathing, air hunger, feeling of suffocation, or breathlessness.

Broken heart syndrome, obesity, higher altitude, extreme temperatures, and a multitude of other medical problems can trigger this symptom. There are two types of dyspnea; acute dyspnea ranges from a few minutes to a couple of hours, and chronic dyspnea can make you struggle for your breath while doing every small task like walking or standing in the same position for a long time.

Cardiogenic Shock

Cardiogenic shock is a symptom in which the heart struggles to pump an adequate amount of blood to meet the body’s requirements. When there is lack is a lack of oxygen in the blood to stimulate its function, the muscles in the heart begin to weaken and further go into cardiogenic shock.

The condition is generally caused by severe heart attack; however, not everyone who has suffered from a heart attack deals with cardiogenic shock. While it is a rare occurrence, it is quite fatal and needs to be treated as an emergency. If patients manage to get immediate treatment, they should have better chances of surviving.

Fainting

Fainting or passing out can be scary; however, it is more common than people think. A person typically retains his or her consciousness with a couple of minutes, quickly recovers, and gets back to normal. However, in some cases, fainting can be a severe sign of mental or cardiac illness.

Passing out due to heart problems occurs when the heartbeat becomes too slow, a condition known as bradycardia or heartbeat getting too fast, which is known as tachycardia. In broken heart syndrome, the heart muscle contracts due to the stress, which creates a shortage of breath, leading to fainting.

Low Blood Pressure (Hypotension)

Low blood pressure or hypotension is another common cause of broken heart syndrome. This situation occurs when the blood pressure reading goes less than 90 millimeters of mercury for the top number, or the bottom number comes at 60 mm Hg. From dehydration to broken heart syndrome and mental illness, there could be various reasons contributing to low blood pressure.

Extreme shock is one of the primary triggers of hypotension. If you feel dizziness, blurred vision, fatigue, nausea, you should get immediate medical treatment. While in ordinary cases, hypotension is not life-threatening, in certain situations, it can be quite fatal.

Heart Failure

Failure is a serious health condition in which the heart is not able to pump an adequate amount of blood to function correctly. It doesn’t imply that the heart stops to work; instead, it is an indication that it is about to stop working. It is a serious condition that needs immediate medical attention.

Heart failure is among the common symptoms of broken heart syndrome as the situation makes the heart weaker. Around 5.7 million people in the US also suffer from heart failure, and it could be the trigger of many heart issues, so you should not ignore it.

Understanding the Difference Between Heartbreak and Heart Attack

There are tons of similarities between heart attack and broken heart syndrome, but there are some key differentiators as well that you should know.

Primary, the condition of heartbreak only occurs when someone is experiencing extreme emotional distress or is going through a stressful situation. In the electrocardiograms, the results for heart attack and broken heart syndrome will be shown differently.

Diagnosis of Broken Heart Syndrome

If you experience any of the symptoms mentioned earlier, it is vital that you take immediate medical treatment. To diagnose broken heart syndrome, your doctor will perform a physical exam and ask for your personal history.

A physical exam is a standard routine test that is conducted by the primary care provider to check your overall health. A PCP might be a doctor, physician assistant, or nurse practitioner. A standard physical exam is also known as a wellness check. In this examination, you can discuss the problems you are facing with regards to your health.

Depending on your age, there are different levels of this examination. And based on your queries and the results of the study, your PCP might recommend additional check-ups. The doctor may also assess your medical history to see whether or not you have any previous heart-related health issues or symptoms that are linked with broken heart syndrome.

Electrocardiogram (ECG)

Electrocardiogram or ECG is a popular test that doctors recommend to check for signs of heart disease. This test records the electrical activity of your ticker via small electrode patches that the lab technician attaches to your bare chest, arms, and legs.

The entire test is safe and painless and helps determine your heart rhythm, blood flow, diagnose the chances of heart attack, abnormal or tightened heart muscles, or any other abnormalities. Basically, ten electrodes with adhesive pads are attached to your skin. On a computer screen, a graph image will show the electrical impulses that transmit through your heart. ECG is also known as resting EKG.

Echocardiogram (Echo)

An echocardiogram displays a graphic outline of the movement of your heart. During this test, ultrasound from a hand-held device is placed on the chest that further provides the images of the heart’s chambers and valves; this graphic image helps the sonographer assess the pumping action of the heart.

An echocardiogram is often performed along with doppler ultrasound and color doppler to evaluate the flow of blood across the valves of your heart. It is performed to assess the overall functioning of your heart, identify the presence of any heart diseases such as broken heart syndrome, valve disease, pericardial disease, myocardial disease, cardiac masses, congenital heart disease, and more.

Blood Test

A blood test can offer many vital clues concerning your heart health. And doctors use a blood test to diagnose whether or not you are suffering from broken heart syndrome. The substance found in your blood can determine the risk of heart issues. If there is a high amount of cardiac enzymes in your blood, then your probabilities of suffering from broken heart syndrome significantly increase.

Typically a blood test takes a couple of minutes to complete and can be performed by a doctor, phlebotomist, nurse, or other health professionals. Generally, patients are recommended to avoid drinking or eating anything 12 hours prior to the test. Certain medications are also avoided before the test.

Cardiac Magnetic Resonance Imaging (MRI)

Magnetic Resonance Imaging (MRI) is an essential noninvasive test that leverages a magnetic field along with radio-frequency waves to develop a detailed picture of various organs and structures of your body. Your doctor might recommend this test to assess your heart and blood vessels.

It is also known as nuclear magnetic resonance imaging (NMR). It should complete heart structure includes muscles, chambers, and valves, and how well blood flows through the major vessels and heart. It determines tissue damage, reduced blood flow, issues in the aorta, heart muscle diseases, heart valve disorders, broken heart syndrome, congenital heart problems.

Coronary Angiogram

A coronary angiogram is a procedure that uses X-rays imaging to see whether blood vessels in your heart. The test is typically executed to see whether there is a blockage in the flow of blood while going into the heart. A coronary angiogram is a part of heart catheterization. It is a procedure that can diagnose as well as treat various heart and blood vessel conditions.

In this type, a type of dye, which is visible by an X-ray machine, is injected into the blood vessels of the heart. In a rapid motion, the X-ray machines take a series of images, providing a better look at the blood vessels.

Learning the Test Results

Once the test results come, there are several clues through which doctors differential between heart attack and broken heart syndrome. Following are some of the differentiating factors:

• An EKG will display the electrical activity not regular but not the same changes that a heart attack results would show.
• Blood tests will reveal no damage to the heart
• There will be no blockage to the arteries
• The left ventricle of heart will be enlarged and will show an unusual contractions
• The cardiac biomarkers will be higher than usual, but not enough to cause a heart attack.

Complications of Broken Heart Syndrome

If you fail to get proper treatment at the right time, then broken heart syndrome can result in severe health conditions. Some complications of broken heart syndrome include:

• Heart Failure

Heart failure, also known as congestive heart failure, is among the common complications associated with broken heart syndrome. In this condition, the heart muscle is unable to pump blood as sufficiently it should. This condition gradually leaves your heart too exhausted to fill up the blood efficiently. It can be a chronic condition that may suddenly become acute.

The people with heart failure often experience a shortage of breath, weakness, swelling of ankles, feet, and legs, irregular heartbeat, persistent coughing, swelling in the abdomen, fluid retention, nausea, lack of appetite, or decreased alertness.

• Pulmonary Edema

Pulmonary Edema is a health condition that is caused by excess fluid retention in the lungs. There are various air sacs in the lungs, where the fluids get accumulated and create complications in breathing. Heart problems are one of the primary causes of Pulmonary Edema.

It is a medical emergency that should be treated immediately. If not treated in a timely manner, the situation can turn out to be fatal. Patients who are suffering from pulmonary edema can experience extreme difficulty in breathing, feeling of suffocation, wheezing, anxiety, persistent cough with a tinge of blood, blue-tinged lips, irregular heartbeat, and clammy skin.

• Heart Valve Disease

In heart valve disease, one or more valves in the heart fail to function correctly. There are four valves in the heart that together work to keep the blood flowing in the required direction. In this condition, one or more valve doesn’t open or close. It can result in the improper flow of blood into the body.

Your heart valve disease treatment entirely depends on the valve that is being affected and the severity of it. Sometimes surgery is performed to repair or replace the heart valve. People who deal with heart valve disease experience symptoms like heart murmur, fatigue, shortness of breath, swelling of feet and ankles, fainting, or dizziness.

• Hypotension (Low Blood Pressure)

Hypotension or low blood pressure is generally not considered a significant health issue. However, a severe case of low blood pressure can be an indication of an underlying problem and can result in severe heart disorders as well as organ failure. This is because, in this case, nutrients and oxygen fail to reach essential organs to functions.

If not treated timely and effectively, it can be a life-threatening situation. An individual with a blood pressure reading of 90/60 mmHg or lower can be suffering from hypotension. Blurred vision, pale skin, depression, palpitations, fatigue, dizziness, shallow breathing, and thirst are some of the common symptoms a person with low blood pressure experiences.

Treatment of Broken Heart Syndrome

When it comes to broken heart syndrome, doctors are equipped with a tiny amount of data. So there are no standard treatment procedures to treat broken heart syndrome. Presently the treatment is similar to a heart attack until the diagnosis becomes clear. Typically, people stay in the hospital until they have completely recovered.

Once the symptoms are apparent, and doctors have confirmed that you are suffering from broken heart syndrome, the doctors are likely to prescribe you with medications such as angiotensin II receptor blockers, angiotensin-converting enzyme, diuretics or beta-blockers. These medications work towards reducing the stress on your heart while you recover from the incident. With proper treatment, patients can recover from this condition in a month.

Your doctor might also recommend another echocardiogram after four to six weeks of the treatment to ensure that you have entirely recovered. Typically, you can stop the medications within three months, but it is important that you consult with your doctor before making any decision. Some procedures that are used to treat heart attacks like surgery, stent placement, or balloon angioplasty are not useful in treating broken heart syndrome. These are treatments that are used to treat blocked arteries, which are not associated with broken heart syndrome.

Stress management, problem-solving, and relaxation techniques are also helpful treatments to improve the physical as well as psychological health of the patient. Managing stress can also be enhanced with physical exercises as well as anxiety medications. People need to avoid poor lifestyle choices to manage their stress, such as overeating, drinking, use of illicit drugs, or smoking.

Prepare For Your Appointment

The diagnosis of broken heart syndrome typically takes place in an emergency setting since a majority of people with such conditions have identical symptoms to a cardiac attack. If you are experiencing any symptoms that last longer than a few moments, immediate call 911 or have someone take you to the emergency room. Even if the cause is something else, it is crucial that you seek direct medical care. Have a friend or family member accompany you to the hospital. Having someone with you can help you stay calm and gather information in a better way.

On your way to the hospital, make sure that you share the following information:

• The symptoms that you are experiencing.
• Important personal information that might be related to the symptoms you are feeling, such as significant stress, a recent lifestyle change, the loss of a job, or the death of a family member.
• Medical history for both you and your family, including high cholesterol, diabetes, heart disease, and other primary health conditions.
• It would help if you also informed the practitioner about the medications you are taking.
• If you have any internal trauma such as a pinched nerve, broken rib, or another health condition, then you should share this vital information.

Once you reach the hospital, you will be directly taken to medical evaluation. Furthermore, based on the results of blood tests, electrocardiograms, your doctor will determine whether you are having a heart attack or symptoms of broken heart syndrome. This is the right time to gather relevant information with regards to your health, such as:

• The cause your symptoms
• The tests you will require
• How long you will be staying in the hospital
• The treatment you will be provided
• The risks associated with the treatments
• Is it a recurring situation

Broken heart syndrome is not a serious condition in general; however, if you do not take timely treatment, the issue can be fatal. The primary cause of this condition is extreme stress, so the person must steer clear from the stressful situation that might make this situation more complicated.

Above, we have mentioned the critical symptoms of broken heart syndrome. If you deal with any of these symptoms for longer than a few moments, then it is crucial that you take immediate medical action so that your condition doesn’t become critical.