Broken Heart Syndrome

Definition

Broken heart syndrome is usually referred to in medical jargon as Takotsubo syndrome or Takotsubo cardiomyopathy. The disease is a sudden, temporary pumping weakness of the heart that occurs after particularly stressful events and is clinically similar to a heart attack. The trigger seems to be the release of stress hormones.

The disease primarily affects women of advanced age. The disease is named after a Japanese squid trap. The shape of this trap is similar to the left ventricle, which has a typical shape in the acute stage of the disease. Although the name “Broken heart syndrome” may not initially suggest it, the disease is an extremely serious and potentially life-threatening clinical picture in the acute stage.

Causes of Broken Heart Syndrome

Broken heart syndrome is a rare disease to date. In recent years, however, there have been indications that the disease is diagnosed much less frequently than it actually occurs. The direct trigger of the disease is an exceptionally strong emotional burden or stress situation.

According to recent findings, severe physical stress situations such as major surgery can also trigger the disease. New studies provide evidence that the hormones and messenger substances such as adrenaline, noradrenaline and metanephrines released in this stressful situation have a direct effect on the heart via receptors and thus severely impair its pumping capacity. This leads to a contraction disorder of the heart muscle in certain areas, namely the apex of the heart (apex cordis) and the middle area of the left ventricle (ventriculus cordis). This contraction disorder results in the typical shaped heart silhouette, reminiscent of the Japanese squid trap, which gave the disease its name. The following topic might also interest you: How can you prevent a heart attack?

What can be the signs of Broken Heart Syndrome?

The signs of Broken Heart Syndrome are similar to those of a heart attack. There may be sudden onset of pain in the left side of the chest. The pain often radiates into the left arm.

It is also possible for the pain to radiate into the upper abdomen or across the neck to the jaw. The pain in the chest is often accompanied by a feeling of pressure and shortness of breath. Nausea, vomiting and heavy sweating can also occur. If one or more of the above symptoms occur, especially if sudden pain in the chest occurs, medical help should be sought immediately.

Diagnostics for Broken Heart Syndrome

In the acute situation, Takotsubo cardiomyopathy impresses like an acute heart attack. The patients complain of sudden onset of severe chest pain and shortness of breath. The patient’s medical history should be asked about a triggering event.

Emotionally stressful events such as the death of a close relative, a serious accident or the diagnosis of a serious illness are possible. However, positive emotional events such as winning the lottery can also be a triggering event. More rarely, strong physical stress reactions such as serious surgery are also supposed to be a trigger.

Clinically, a heart attack cannot be distinguished from a broken heart syndrome, but in the case of a heart attack there is in most cases no identifiable trigger. It is often not easy to differentiate between them in the ECG. In both diseases, so-called ST segment elevations occur.

While in myocardial infarction they can usually be assigned to the supply area of a particular coronary vessel, the elevations in broken heart syndrome are usually more diffuse. However, a reliable differentiation is not possible by means of an ECG. The typical elevation of cardiac enzymes in myocardial infarction is also elevated in broken heart syndrome.

In most cases, however, they are less pronounced than in the case of a myocardial infarction. However, the level of certain stress hormones in the blood is significantly higher than in patients with a heart attack. However, the determination of hormone levels is not part of basic diagnostics and is not reliable enough.

A reliable distinction between myocardial infarction and Broken Heart Syndrome is primarily possible by means of a cardiac catheter examination. In the case of a heart attack, occlusions in the area of the coronary arteries can be seen here, whereas they are not seen in Broken Heart Syndrome. In addition, the typical heart form of Takotsubo cardiomyopathy is also noticeable during cardiac catheterization. A cardiac ultrasound examination (echocardiography) should also be performed and provides clear indications of the presence of Broken Heart Syndrome, since typical wall movement disorders are evident here.