Broken Heart Syndrome: Description
Broken heart syndrome is a sudden dysfunction of the left ventricle of the heart caused by severe stress. It is classified as a primary acquired heart muscle disease (cardiomyopathy).
It therefore affects only the heart and is not congenital, but occurs in the course of life. Other names for the disease are stress cardiomyopathy and Tako-Tsubo cardiomyopathy or Tako-Tsubo syndrome.
In most cases, broken heart syndrome is initially mistaken for a heart attack because it causes the same symptoms. In contrast, however, the affected person does not suffer from an occlusion of a coronary vessel. While broken heart syndrome is less life-threatening than a heart attack, serious complications can still occur.
Who is affected by broken heart syndrome?
Tako-Tsubo cardiomyopathy was first described in the 1990s and has since been studied only in small groups of patients. Therefore, there is not yet a large amount of data that can be used to determine the frequency of the disease.
It is estimated that approximately two percent of all patients and as many as seven percent of women who are hospitalized with a suspected ST-segment elevation myocardial infarction have broken heart syndrome.
Broken Heart Syndrome: Symptoms
The symptoms of broken heart syndrome are indistinguishable from those of a heart attack. The affected person suffers from shortness of breath, feels a tightness in the chest and sometimes even has severe pain there, which is also called annihilation pain. Often, blood pressure drops (hypotension), the heartbeat accelerates (tachycardia), and sweating, nausea, and vomiting occur.
Due to the functional restriction of the heart, symptoms of cardiac insufficiency also frequently occur. For example, blood backs up into the lungs and venous vessels because the heart can no longer pump it sufficiently into the circulation. The result can be fluid accumulation (edema) in the lungs and legs. These symptoms often trigger a fear of death.
Complications
In the case of a pronounced pumping weakness of the heart, a so-called cardiogenic shock can also occur. The blood pressure then drops so sharply that the body is no longer supplied with sufficient oxygen. Without timely treatment, this complication is also often fatal.
About half of the patients with broken heart syndrome suffer complications of the cardiovascular system.
Broken heart syndrome: causes and risk factors
In the vast majority of cases, broken heart syndrome is preceded by great emotional stress. This can be, for example, separations or the death of a loved one, which explains the name of the disease. Traumatizing events such as natural disasters or violent crimes, as well as situations that threaten a person’s existence, such as the loss of a job, can also cause broken heart syndrome.
Recent research has also shown that even positive stress can cause Tako-Tsubo cardiomyopathy. Accordingly, joyful events such as a wedding, a birthday or winning the lottery are also possible causes of this form of heart muscle disease, although much less frequently than negative stress.
Exactly how emotional stress leads to dysfunction of the heart muscle and the physical symptoms of a heart attack is not yet fully understood. However, in many patients with broken heart syndrome, elevated concentrations of certain stress hormones can be found in the blood.
For example, so-called catecholamines such as adrenaline and noradrenaline are increasingly released by the body. Researchers suspect that the stress hormones act on the heart muscle and lead to circulatory disorders and cramps there.
Female sex hormones (estrogens) have a protective effect on the heart. Since their concentration in the blood decreases after menopause, this is a possible explanation for the fact that it is mainly older women who are affected by broken heart syndrome.
Broken heart syndrome: examinations and diagnosis
In particular, the initial examinations of a broken heart syndrome are no different from those of a heart attack. In both cases, the physician performs a comprehensive diagnosis as soon as possible, which helps him to detect or rule out a heart attack.
Broken heart syndrome shows many similar results in the examinations, but also has crucial differences:
Echocardiography
At the end of the heartbeat (systole), the heart looks like a jar with a short neck. This shape is reminiscent of a Japanese octopus trap called “tako-tsubo”.
In addition, as a result of the heart failure that often results, echocardiography can often detect an accumulation of fluid in the lungs. A heart attack can present itself in a similar way and therefore cannot be ruled out on the basis of echocardiography alone.
Electrocardiogram (ECG)
In the ECG, too, the curve progression in stress cardiomyopathy resembles a heart attack. Namely, changes in the electrical activity of the heart occur, as is typical for an oxygen deficiency of the heart muscle. However, these changes usually appear in all curves (leads) of the ECG and not only for a specific area of the heart muscle, as is usually the case with a heart attack.
Blood values
As in myocardial infarction, after a few hours the concentrations of certain enzymes such as troponin T or creatine kinase (CK-MB) rise in the blood. However, the increases are usually less than in an infarction and do not match the otherwise marked results of cardiac ultrasound and ECG.
Angiography
Patient interview
When talking to patients with acute heart complaints, the physician is particularly interested not only in the symptoms but also in whether the event was preceded by an intense emotional stress situation. If this is not the case, broken heart syndrome is unlikely. Here one must be careful: because stress can also lead to a real heart attack.
Broken Heart Syndrome: Treatment
Currently, there is no single regimen for treating Tako-Tsubo cardiomyopathy. Because life-threatening complications can occur, especially in the first few hours, patients are monitored for some time in an intensive care unit.
The effect of stress hormones and, in particular, the increased activity of the stimulatory sympathetic nervous system can be curbed by certain drugs such as beta-blockers. They reduce cardiac stress. Cardiac arrhythmias and any symptoms of heart failure can also be treated with appropriate medications.
Broken heart syndrome: disease progression and prognosis
Of all heart muscle diseases, Tako-Tsubo cardiomyopathy has the best prognosis. Symptoms often resolve within the first few hours. Only rarely does permanent damage to the heart result. However, if the patient is predisposed to the disease, the risk of a recurrence of stress cardiomyopathy is about ten percent.
