popular science

broken heart syndrome — takotsubo cardiomyopathy

Have you ever thought that you are so broken hearted beyond rapair? So much that you think the death is inevitable?

No doubt losing a loved one, for example, (literally or figuratively) is extremely painful, but are there any documented cases of anybody actually dying from this?

As it turns out, it isn’t just a Shakespearian story.

Takotsubo cardiomyopathy is a weakening of the left ventricle, the heart’s main pumping chamber which temporarily becomes ballooned and enlarged so that it doesn’t pump properly.

This usually happens as the result of severe emotional or physical stress, such as a sudden illness, the loss of a loved one, miscarriage, a serious accident, or a natural disaster such as an earthquake.

That’s why the condition is also called stress-induced cardiomyopathy, or broken-heart syndrome. The main symptoms are chest pain and shortness of breath.

Most of the time, a person who had a literal broken heart (syndrome) situation, will successfully recover and well, don’t die, even though it might have felt that way.

Takotsubo etymologically comes from the term for the Japanese fishing pot used to trap octopuses. The odd shape the heart takes when the ventricle becomes enlarged truly resembles a takotsubo, hence the name.

The condition is often triggered by emotional stress, such as the death of a loved one or the loss of a job. But it may also be triggered by physical stress, such as an asthma attack or major surgery.

Symptoms of the broken-heart syndrome can resemble those of a heart attack and include chest pain and shortness of breath. But unlike a heart attack, there is no blockage of the heart’s arteries, and patients usually make a full recovery within days to weeks.

But about 1 in 10 patients with broken-heart syndrome experiences cardiogenic shock, a life-threatening complication in which the heart suddenly cannot pump enough blood to meet the body’s needs.

The female lead in broken hearts

This rather romanticized condition known as takotsubo cardiomyopathy, first described in 1990 in Japan. More than 90% of reported cases are in women ages 58 to 75. Many re suggests that up to 5% of women evaluated for a heart attack actually have this disorder, which has only recently been reported in the United States and may go largely unrecognized. Fortunately, most people recover rapidly with no long-term heart damage.

Stressors associated with takotsubo cardiomyopathy

  • A sudden drop in blood pressure
  • Serious illness, surgery, or medical procedure (e.g., cardiac stress test)
  • Severe pain
  • Domestic violence
  • Asthma attack
  • Receiving bad news (such as a diagnosis of cancer)
  • Car or other accident
  • Unexpected loss, illness, or injury of a close relative, friend, or pet
  • Fierce argument
  • Financial loss
  • Intense fear
  • Public speaking
  • A surprise party or other sudden surprise

The precise cause isn’t known, but experts think that surging stress hormones (for example, adrenaline) essentially “stun” the heart, triggering changes in heart muscle cells or coronary blood vessels (or both) that prevent the left ventricle from contracting effectively. Researchers suspect that older women are more vulnerable because of reduced levels of estrogen after menopause.

In studies with rats whose ovaries had been removed, the ones given estrogen while under stress had less left-ventricle dysfunction and higher levels of certain heart-protective substances.

Broken-heart syndrome mimics the symptoms of a heart attack (i.e., heaviness in chest, shortness of breath, abnormal EKG), but the tell-tale sign is always the presence of the takotsubo pot upon x-ray. 70% of the documented cases thus far have been correlated with negative emotional stressors. The good news is that with proper recognition and management, nearly all patients survive a heartbreak episode.

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