Broken Heart Syndrome / Takotsubo Cardiomyopathy

What is Broken Heart Syndrome?

The first thing that comes to mind when one hears the name ‘broken heart syndrome’ is the typical traumatic scene in Indian cinema. A mother hears of her son’s death, and she collapses. An entrepreneur hears of his partner cheating him of his business empire, and he clutches his heart in pain. Well, there is relevance to that acting since these could possibly indicate the condition of broken heart syndrome.

Broken heart syndrome is precipitated by an extremely stressful event leading to severe but relatively short-term failure of the heart muscles.

In the 1990s, broken heart syndrome was first identified by Dote et al. among 5 Japanese and was named as Takotsubo Cardiomyopathy. The name Takotsubo is a Japanese word which means “fishing pot for trapping octopus”. The left ventricle of the heart bloats up into a balloon shape or the shape of a fishing pot trap for an octopus, but there is no block in the blood supply to the heart, which usually happens in a heart attack. It is also called Takotsubo Syndrome (TTS).

What are the Causes of Broken Heart Syndrome?

Exactly how the broken heart syndrome arises is not very clear. There are numerous hypotheses that have been put forth to explain how broken heart syndrome occurs. A sudden physical or stressful emotional situation like sudden loss of loved ones, death, separation or divorce, financial problems, extreme pain, illness, anger, war, or environmental disasters like tsunami releases chemicals called catecholamines in the body, which include epinephrine (adrenaline) and norepinephrine. These chemicals may affect cardiac muscle and cause broken heart syndrome.

Viral agents, spasms of the coronary artery, problems at the level of small blood vessels supplying the heart and genetic mutations have been suggested as potential causes, but they have not been confirmed through any research evidence.

Increased oxidative stress i.e. the production of damaging free oxygen radicals, appears to be a relevant cause for the symptoms of broken heart syndrome. Estrogen deficiency also appears to be another cause since it reduces the protective effect of estrogen on the heart.

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Nearly 90% of women who experience broken heart syndrome are post-menopausal. Use of drugs such as cocaine and opioids or presence of certain brain disorders, such as epilepsy, migraine, traumatic brain injury, stroke, among others could also possibly contribute to the development of broken heart syndrome.

A recent research study observed that sometimes happy events could also cause or trigger broken heart syndrome.

What are the Symptoms of Broken Heart Syndrome?

Broken heart syndrome affects women predominantly. Some of the symptoms include:

• Intense chest pain that occurs suddenly after a physical or mental stressful event
• Difficulty in breathing
• Low blood pressure
• Recovery within a month
• Swelling of feet

How Do You Diagnose Broken Heart Syndrome?

During the diagnosis of broken heart syndrome, the doctor first tries to rule out the possibility of coronary artery syndrome. The patient’s medical and physical history is taken. The doctor will ask the patient or the attendant about the symptoms, when the symptoms began, and where they are being felt. The individual is asked pertinent questions regarding family history, genetic risk factors, and possible stress factors.

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Some of the techniques used for diagnosis are cardiac magnetic resonance imaging, electrocardiograms echocardiography, angio computed tomography, and lab tests for creatine kinase, catecholamines, among others. Most of these techniques are used to detect heart attacks as well. A combination of results from these tests helps confirm the condition. Tests like ultrasound may be used to detect adrenal tumors, which normally secrete catecholamines and may also cause high levels.

Coronary Arteriography: During this procedure, a catheter or tube is inserted into the coronary arteries to release a dye. Images are then taken to observe the flow of blood through the blood vessels. The patient with broken heart syndrome does not have any obstruction in the coronary blood vessels. This test helps differentiate broken heart syndrome from a heart attack or angina.

Chest X-ray: Pictures of the heart can be obtained with a chest x-ray. An enlarged heart (a potential sign of broken heart syndrome) can be detected with a chest x-ray.

Electrocardiogram (ECG): This test measures the electrical signals that are generated from the heart. Abnormalities in electrocardiogram readings in broken heart syndrome resemble that of a heart attack (T-wave inversions; elevated ST-segment). Irregularities in heartbeat may also be noted.

Blood Tests: The diagnosis of broken heart syndrome is benefited by blood tests that measure the levels of cardiac enzymes, which are released into the blood when the cardiac muscle is damaged. The enzymes may be slightly increased, in contrast to a heart attack, where the levels are much higher.

Echocardiograph (Echo): This technique uses sound waves to produce an image of the heart. In a broken heart syndrome, the echocardiograph shows inflation of the left ventricle into a balloon shape.

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Cardiac MRI: A combination of magnets, radio waves, and the computer helps in providing images of the beating heart and the associated blood vessels. The images provide information about the condition of the heart and the presence of any blocks.

Ventriculogram: This test uses a dye within the left ventricular chamber if the ventricle is pumping blood well. The left ventricle is usually ballooned in broken heart syndrome.

How Do You Treat Broken Heart Syndrome?

Broken heart syndrome can be confused with a heart attack. Once accurately diagnosed, patients can be treated and can quickly return to a normal routine. In most cases, the treatment involves supportive care. Since the condition is rare, the appropriate treatment has not been confirmed.

Beta blockers are recommended for treatment of broken heart syndrome since they block the effect of catecholamines on the heart. They lower the blood pressure and help slow down the heart rate. However, some research data provides a contradictory opinion on the use of beta blockers in this condition.

Anti-anxiety medications are prescribed to deal with stress; angiotensin-converting enzyme inhibitors (ACE) are recommended to lessen the load on the heart by reducing the blood pressure; diuretics are prescribed to those who have fluid build-up on their ankles, feet, or lungs.

Health Tips

• Avoid unnecessary stress to reduce the risk of broken heart syndrome
• Share your feelings with family and friends
• Ask for help and support from friends and loved ones to cope with stress
• Have a positive look on life