Are increasing instances of broken heart syndrome, fact or fiction?
ALSO known as stress cardiomyopathy, the condition commonly referred to as ‘broken heart syndrome’ has increasingly come under the spotlight in recent times, leaving many questioning whether it is, in fact, a real medical condition.
According to Dr Pieter van Wyk, a cardiologist practicing at Netcare Sunninghill and Netcare Sunward Park hospitals, “While we are all familiar with the notion of ‘dying of a broken heart’, which is commonly referred to in many literary works, broken heart syndrome is in actual fact a condition that has been well researched and documented in the medical world.
“However, while in fictitious terms it most often refers to heartbreak resulting from romantic betrayal, rejection or loss – from a medical perspective stress cardiomyopathy is most often triggered by intense physical or emotional stress resulting from various stressors.
“This typically includes intense emotional and/or physical trauma such as being diagnosed with a serious medical condition, a motor vehicle accident or the news of a family member passing away.”
Research indicates that the condition is most prevalent in older people between the ages of 62 and 75, with more than 80% of patients being women.1,2
Dr Van Wyk first became interested in the subject while working in Christchurch, New Zealand, with cardiologist Dr Christina Chan, who has a special interest in stress cardiomyopathy. She later went on to complete a Master of Medical Science degree on the effects of stress on the heart.
Dr Van Wyk recalls how 21 women presented with stress cardiomyopathy at the public hospital in Christchurch where he was working, following an earthquake in February 2011, in which 185 people died.
“While the heart condition they suffered did not result in any fatalities and was transient in nature in most of the cases, the condition re-occurred at least three times in one of the patients,” he notes.
So what exactly is stress cardiomyopathy? Dr Van Wyk explains that in instances of stress cardiomyopathy part of the heart essentially stops working properly and as a result does not pump optimally. “In most cases the condition involves a balloon-like effect occurring in the apex, the lower end of the heart, and for this reason, it is often also referred to as apical ballooning syndrome.
“People in whom the condition manifests itself generally experience sudden, intense chest pain and shortness of breath, which are similar symptoms to those experienced during a heart attack. However, stress cardiomyopathy is in fact a completely different condition,” he notes.
Dr Van Wyk goes on to emphasise that people suffering from stress cardiomyopathy do not usually have coronary heart disease, which causes a heart attack.
“A heart attack occurs in people with coronary heart disease, also known as coronary artery disease, when one of the arteries that supply blood to the heart gets blocked and this, in turn, causes damage to part of the heart muscle.
Generally speaking, it is only necessary to take medication temporarily until the condition improves, however some people do need to take it for the rest of their lives
Dr Van Wyk cautions that during the acute phase, stress cardiomyopathy seems to be just as severe as a heart attack and can lead to serious heart problems. “It may, for example, lead to further heart rhythm problems that cause the heart to beat much faster or slower than normal. It can also result in heart failure, ie, the heart underperforms in pumping enough blood through the body. The worst case scenario is that the heart failure could result in death. However, if the acute phase is survived then almost every person with stress cardiomyopathy recovers completely within one to four weeks.”
Due to the similarity of the symptoms when it comes to heart attacks and stress cardiomyopathy, Dr Van Wyk emphasises the importance of tests to determine the exact cause of the symptoms being experienced.
“With stress cardiomyopathy, the heart releases certain chemicals that will show up in blood tests, similar to that seen in a heart attack. A chest x-ray is often used to show if there is fluid in the lungs and also provides an indication of the general shape of the heart and large blood vessels in the chest.
“Electrocardiograms, or ECGs, which measure the electrical activity in the heart; echocardiograms, using sound waves to create a picture of the heart as it beats; and coronary angiograms, which reveal narrowed or blocked arteries, are also commonly used to enable an accurate diagnosis.”
Most people are treated with medication which, Dr Van Wyk says, are prescribed based on the individual’s symptoms and any specific complications caused by the stress cardiomyopathy.
“Generally speaking, it is only necessary to take medication temporarily until the condition improves, however some people do need to take it for the rest of their lives. And while patients recover from stress cardiomyopathy, it may reoccur in approximately two percent of individuals.
“While significant inroads have been made into determining its exact cause over the years, there are a multitude of differing factors at play when it comes to both the diagnosis and treatment of stress cardiomyopathy. However, broken heart syndrome remains a real and sometimes serious medical condition that requires medical intervention,” Dr Van Wyk concluded.
2.) Eitel I, von Knobelsdorff-Brenkenhoff F, Bernhardt P, et al. Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy. JAMA. 2011;306:277–286. [PubMed]