Broken Heart Syndrome (Takotsubo Cardiomyopathy)

Dr. Nabi Darya Vali (AIIMS)MBBS

July 10, 2020

July 10, 2020

Broken Heart Syndrome
Broken Heart Syndrome

Broken heart syndrome, also called takotsubo cardiomyopathy or stress-induced cardiomyopathy, is a reversible condition that affects the lower left ventricle of the heart. 

The condition is triggered by stress—physical or mental. It presents with symptoms similar to a heart attack and is often misdiagnosed as one. However, patients with broken heart syndrome do not show the typical blockages in blood vessels that cause a heart attack

There is no specific treatment for a broken heart. Patients are given medications for heart problems.

Here is all you need to know about broken heart syndrome.

What is broken heart syndrome?

Broken heart syndrome is an acute (sudden onset) but reversible heart condition that is characterized by weakening of the muscles of the left ventricle of the heart. The left ventricle changes its shape to look like a takotsubo—a sort of octopus trap. Hence, it is also called takotsubo cardiomyopathy. Takotsubo cardiomyopathy was first described by a Japanese cardiologist in 1990.

The human heart has four chambers: two atria (upper chambers) and two ventricles (lower chambers). The right atrium receives blood from the body and sends it to the right ventricle, which then sends it to the lungs for oxygenation. From the lungs, the blood comes back to the left atrium and then to the left ventricle. The left ventricle then pushes the blood out to the entire body. 

Since the shape of the left ventricle is impacted in broken heart syndrome, it affects the ability of the heart to pump blood to the body.

Broken heart syndrome symptoms

A patient with broken heart syndrome presents with the following symptoms:

Broken heart syndrome causes and risk factors

Broken heart syndrome is caused due to stress, either physical or mental. Hence, the name stress cardiomyopathy.

According to Johns Hopkins Medicine, stress is our body’s response against things it perceives to be abnormal. The cause could be physical like dehydration or emotional like losing a loved one. When this happens, our body produces its fight or flight hormone adrenaline. This hormone makes the heart push more blood into the body, increases blood glucose levels and blood pressure. It also dilates blood vessels, so your muscles can get more oxygen in case you need to run away from the situation. 

Exactly how stress affects the body is unknown. However, it is suggested that a person’s heart is unable to cope with high adrenaline levels during stress, and as a result, the left ventricle gets misshapen.

The condition is more prevalent in women than men, especially after menopause. 

According to medical experts, some of the stressors associated with broken heart syndrome are:

  • Sudden surprise or a scare: getting bad news is just as much of a risk as getting very good but very unexpected news
  • An asthma attack
  • Being diagnosed with a chronic and potentially fatal disease
  • A major accident
  • Death of a loved one or some kind of unexpected incident or loss
  • Financial issues
  • Domestic violence
  • Excessive fear. Example, fear of public speaking
  • A sudden drop in blood pressure

Broken heart syndrome diagnosis

Broken heart syndrome is usually mistaken for a heart attack. However, the condition usually presents after a sudden incident or stress, unlike a heart attack.

Doctors check the medical history of a patient to diagnose the condition and the following tests are done:

  • Electrocardiogram (ECG): An electrocardiogram registers the electrical activity of the heart. Both heart attack and stress cardiomyopathy show similar results in an ECG. 
  • Blood tests: A troponin test is usually done to check for injury to the heart muscles. Troponin is a protein found in heart muscles. In the case of heart muscle injury, this protein is found in the blood. Again, both heart attack and broken heart syndrome patients have this protein in their blood. However, the blood troponin levels are much lower in broken heart syndrome.
  • Echocardiogram: This is a type of ultrasound that helps to check heart movements and the shape of the heart.

The doctor may also perform a coronary angiogram to check for blockages in the blood vessels of your heart (coronary artery). Often, people who have a heart attack have blockages in their coronary artery while the same does not occur in stress cardiomyopathy.

Broken heart syndrome treatment

There is no treatment for broken heart syndrome. 

Patients are treated with medicines used to treat heart failure. These include beta-blockers, ACE inhibitors, and diuretics that will help the affected muscles of the heart to recover. 

Most patients take one week to one month to recover, and the damage is not permanent. The condition rarely recurs. However, the patients are asked to avoid stress.

In about 20% of the cases, heart failure occurs.



References

  1. Vakamudi Mahesh. ‘Broken-heart syndrome’… Be aware... Indian J Anaesth. 2016 Mar; 60(3): 155–156. PMID: 27053776.
  2. American Heart Association [internet]. Dallas. Texas. U.S.A.; Is Broken Heart Syndrome Real?
  3. Hormone Health Network [Internet]. Endocrine Society. Washington D.C. US; What is Adrenaline?
  4. Science Direct (Elsevier) [Internet]; Adrenaline
  5. Johns Hopkins Medicine [Internet]. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System; Frequently Asked Questions about Broken Heart Syndrome
  6. Harvard Health Publishing. Harvard Medical School [internet]: Harvard University; Takotsubo cardiomyopathy (broken-heart syndrome)
  7. St. Vincent's Hospital Heart Health [Internet]. St. Vincent's Health. Australia; Takotsubo Cardiomyopathy

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