What Is Broken Heart Syndrome?

By Marina Artemiou

Contrary to popular belief, a broken heart is not just folklore. Instead, it is an actual heart condition called Stress Cardiomyopathy or Takotsubo Syndrome. Many of you have most likely experienced a “hollow feeling” in your chest or even a quite painful feeling following an extreme emotional event or a very stressful situation, e.g. before going into an exam room or after a breakup. Many people mistake this feeling for a heart attack, but this is far from correct. What is actually happening is that your heart is quite literally getting weaker from these extreme emotions experienced. This only occurs at distinct areas of the heart and temporarily disrupts heart contractility and blood flow, as the rest of the heart continues to work normally (CardiomyopathyUK; Ramaraj, 2007). 

What actually happens to bring about stress cardiomyopathy is still under investigation but there are some distinct and profound differences between the hearts of healthy individuals and individuals with “broken hearts”. The most common change observed is a pattern of ventricular systolic dysfunction which was determined by conducting cardiac ventriculography (Ramaraj, 2007). This is a medical imaging technique where imaging media is injected into the ventricles thereby allowing visualisation of the working cardiac muscle, and blood moving along the multiple chambers. Individuals with “broken hearts” showed hypokinesis or akinesis from the mid portion to the apical area of the ventricle and hyperkinesis of the basal area when looking at the left ventricle of the heart. Because the end-systolic left ventriculogram looked like a “tako-tsubo”, a Japanese trap used to catch octopuses which has a similar shape to a heart with this condition, the condition was initially named as such; Takotsubo Syndrome. The consequence of this syndrome is the weakening of the left ventricle, which is responsible for pumping blood to systemic circulation, and particularly at the tip of the ventricle which appears enlarged (Ramaraj, 2007).

Broken heart syndrome exhibits physiological symptoms very similar to those of myocardial infraction. These symptoms often occur immediately or within minutes of a person being exposed to an extremely emotional or stressful situation, and include angina, shortness of breath, arrythmia, low blood pressure, fainting and cardiogenic shock. As mentioned above, most people experiencing stress cardiomyopathy often mistake this for a heart attack, this is mainly because of the pain they will be experiencing on the left side of their body, specifically their left arm and left side of their chest. The reason for the pain experienced in the left arm is attributed to the fact that afferent neurones which branch from the heart and left arm, signal to the same area of the brain. Consequently, the brain is unable to distinguish from where the signal originates and hence both chest and arm pain is experienced. Luckily, these symptoms are usually short-lived, unlike those of a heart attack which persist, and sufferers of this syndrome often do not require immediate hospitalisation (CardiomyopathyUK; Ramaraj, 2007).

Despite the fact that the effects of broken heart syndrome are usually short-lived and more often than not go away on their own without the need for medical intervention, the more extreme cases may require pharmacological interference to be managed. Initially, broken heart syndrome symptoms are treated like those of a heart attack as there is no way of distinguishing between the two conditions without making a thorough diagnosis. Once the correct diagnosis is made, broken heart syndrome can be treated using ACE inhibitors to lower blood pressure, beta blockers to reduce heart contractility and heart rate, diuretics to decrease total circulating blood volume and vascular tone and anti-anxiety medication to reduce stress and reduce the recurrence of the syndrome. Counselling and therapy may also be used to provide the patient with tools and methods to tackle extreme emotional events in a safer manner in the future (Cleveland Clinic, 2018).

There are currently no treatments for preventing broken heart syndrome but learning effective stress management techniques, problem-solving as well as relaxation and breathing techniques which can help improve psychological health may prove useful when it comes to facing extreme emotional and stressful situations. It may also be useful to note that broken heart syndrome occurs much more frequently in women when compared to men, as women are much more likely to be severely affected by emotional situations as well as exhibit greater stress levels (Cleveland Clinic, 2018).

In conclusion, despite the harsh name given to the condition, it is not something that individuals should be afraid of as it is not life-threatening and cannot result in permanent damage. Instead, it is advised that people who are at risk learn how to manage their trauma and lead a stress-free life.

References:

CardiomyopathyUK. (n.d.) Takotsubo Cardiomyopathy. Available from: https://www.cardiomyopathy.org/takotsubo-cardiomyopathy/intro. [Accessed on 24th November 2020]

Ramaraj R. (2007) Postgraduate Medical Journal. Stress cardiomyopathy: aetiology and management. 83(982): 543–546. Available from: doi: 10.1136/pgmj.2007.058776 [Accessed on 24th November 2020]

Cleveland Clinic. (2018) Broken Heart Syndrome: Management and Treatment. Available from: https://my.clevelandclinic.org/health/diseases/17857-broken-heart-syndrome/management-and-treatment [Accessed on 24th November 2020]

Cleveland Clinic. (2018) Broken heart syndrome: prevention. Available from: https://my.clevelandclinic.org/health/diseases/17857-broken-heart-syndrome/prevention [Accessed on 24th November 2020]

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