BROKEN HEART SYNDROME

 OVERVIEW

Most individuals at a point in their lives have suffered from a broken heart. We often get hurt when we receive messages like; “it’s over between us”, “sorry, your mum couldn’t make it, we lost her”, “you aren’t good enough for this task”, and among others. The birth of this popular quote, “I’d rather have a broken arm than a broken heart” is as a result of the excruciating pain that comes with a broken heart.

Come to think of it, does your heart really break physically?

Heartbreak is a metaphor that has been used over the years to represent an emotional stress or pain one feels at experiencing great deep longing. Now, scientists say that the pain from a broken heart isn’t just emotional but physical too. So yes, in some cases there is a physical injury to the heart which causes your heart muscles to get weaker and change in structure.

Not all people who have a broken heart will end up with broken heart syndrome. It all depends on one’s ability to cope with stress.

What then is broken heart syndrome?

Broken heart syndrome is a group of symptoms which present when there is a sudden temporary weakening of the heart muscles as a result of stressful situations and extreme emotions.

It usually follows deep emotional experience such as near-death experience, loss of a loved one, severe financial distress, physical or verbal abuse, a memory of a bad event, and among others.

It is interesting to know that it’s not always caused by negative experience but sometimes even positive ones such as; winning a lottery, a surprise party, public speaking etc.

Serious illness, surgery or medical procedures and certain drugs may also contribute to this syndrome.

Other names given to this syndrome include; stress-induced cardiomyopathy, Takotsubo cardiomyopathy, apical ballooning syndrome.

What happens during broken-heart syndrome?

The actual mechanism behind this unusual phenomenon remains unclear, but it is believed that within a few hours of extreme emotional or physical trauma, stress hormones such as adrenaline are released in high quantities. The surge of these hormones plays a role in causing transient stunning of the left ventricle. The adrenaline surge causes constriction of the peripheral arteries thereby raising blood pressure and placing more stress on the heart. It may also lead to spasm of the coronary arteries supplying blood to the heart muscle. This impairs the arteries from delivering adequate blood flow and oxygen to the heart muscle. These events lead to the weakening of the ventricular muscles which results in low cardiac output and present similar to a heart attack.

Signs and Symptoms

Symptoms of broken heart syndrome appear suddenly, following a stressful event.

Patients with the broken-heart syndrome usually experience symptoms that are clinically indistinguishable from the acute coronary syndrome.

  • chest pain or pressure
  • shortness of breath
  • dizziness
  • rapid heartbeats
  • fainting
  • arrhythmia
  • Diaphoresis

If you are experiencing any of these symptoms after going through emotional stress, it’s more likely you have broken heart syndrome. Most importantly, you have to see your doctor because it might be a heart attack since it has similar symptoms.

How is broken heart syndrome diagnosed?

To differentiate broken heart syndrome, history and physical examination of the patient is very important due to the factors that lead to the disease.

Since it’s indistinguishable from a heart attack, the following are some of the tests done to rule out a heart attack.

  • Electrocardiogram (ECG) is used to measure the heart’s electrical activity. Often manifest on ECG as “ST” changes similar to that of a heart attack.
  • Echocardiogram is used to see if your heart has an abnormal shape, and pumps normally. In case of broken heart syndrome, the left ventricle usually has a poor pumping activity.
  • Blood tests may often show high levels of substances called cardiac enzymes in the blood.
  •  Coronary angiogram uses dye and a type of X-ray to take pictures inside the heart’s arteries. Results are usually normal as compared to that of a heart attack which is partially or completely blocked.

How is broken heart syndrome different from a heart attack?

Differentiating the two is not an easy task for clinicians. It requires a definitive diagnostic tool like the coronary angiogram to detect whether the heart vessels are blocked or not.

Heart attacks are generally caused by a complete or partial blockage of a heart artery. This blockage is as a result of a blood clot forming in the wall of the artery from fatty buildup (atherosclerosis). In broken heart syndrome, the heart arteries are not blocked, although blood flow in the arteries of the heart may be reduced.

Treatment

Although broken heart syndrome can occasionally be fatal, most people recover within days or weeks. Symptoms of broken heart syndrome are usually treated like those of a heart attack. Once a diagnosis is made, broken heart syndrome is treated with medications such as

  • ACE inhibitors to lower blood pressure
  • beta blockers to slow the heart rate
  • Diuretics to decrease fluid buildup
  • Anti-anxiety medications to manage stress.

As treatment of broken heart takes a few days or weeks, we know that emotional scars take a little bit longer. Practice the following to avoid broken heart syndrome when you are emotionally or physically stressed.

  1. Get a support system. Speak to someone, share your problems with a friend, relative or better still a psychologist. Problem shared is half solved.
  2. Learn to forgive
  3. Cry if you feel like
  4. Exercise
  5. Eat healthily
  6. Have good rest
  7. Give someone a hug
  8. Practice leisure activities
  9. Avoid drinking alcohol, overeating, illicit drug use or smoking.

For more tips on developing stress-resilient attitudes, read our article on stress

The prognosis is typically encouraging, with about 95% of patients experiencing complete recovery within weeks.

Broken heart syndrome if left unattended may result in complications in the early stage such as;

  • Left heart failure
  • Shock (specifically cardiogenic)
  • Mitral regurgitation
  • Ventricular arrhythmias
  • Left ventricular mural thrombus formation
  • Left ventricular free-wall rupture
  • Death

How common is broken heart syndrome?

Broken heart syndrome was first described in Japan in 1990 by Sato et al. The Japanese word “takotsubo” translates to “octopus pot,” or “octopus trap” a round-bottomed, narrow-necked vessel used to catch octopuses. It is named after this condition due to the resemblance of the shape of the left ventricle during pumping (systole) to this pot on imaging studies.

Broken heart syndrome is rare, affecting between 1.2% and 2.2% of people in Japan and 2% to 3% in Western countries who suffer a heart attack. It also affects women far more than men with 90% of cases being postmenopausal women.

The average ages at onset are between 58 and 75 years. Less than 3% of cases occurred in patients under age 50. It is not likely for the same recovered patient to experience the syndrome twice, although it has happened in rare cases.

In a literature review of cases in which race was reported, Asians recorded the highest incidence of about 57.2% of patients, 40% were white, and 2.8% were other races.

A recent study found that widows and widowers were 41 per cent more likely to die within the first 6 months after losing their spouse.

Take home message

In life we don’t always get what we want; hopes and dreams get washed away so easily, chances are missed, closed ones are lost, hearts are broken, but always remember it always gets better with time.

So far as you have life, there is hope. A living dog is better than a dead lion.