Broken heart syndrome

Broken heart syndrome is a temporary
heart condition brought on by stressful situations, such as the death of
a loved one. Many people who have broken heart syndrome may have sudden
chest pain or may think they're having a heart attack. These broken
heart syndrome symptoms may be brought on by the heart's reaction to a
surge of stress hormones. In broken heart syndrome, a part of your heart
temporarily enlarges, a condition called cardiomyopathy.

First described medically in 1991 by Japanese doctors, the condition was
originally called takotsubo cardiomyopathy. Takotsubo is a type of pot
used by Japanese fishermen to capture octopuses. When doctors take X-ray
images of a person who's experiencing broken heart syndrome, part of
his or her heart resembles the pot. Today, the condition is also
referred to as stress cardiomyopathy, stress-induced cardiomyopathy or
apical ballooning syndrome.

Broken heart syndrome is treatable, and usually requires about a week to recover.

Symptoms

Broken heart syndrome can mimic a heart attack, with common symptoms
being chest pain or shortness of breath. Any long-lasting or persistent
chest pain could be a sign of a heart attack, so it's important you take
it seriously and call 911 if you experience chest pain.

When to see a doctor
If you're having any chest pain or shortness of breath after a stressful event, seek emergency medical assistance immediately.

Causes

It's thought that a brief surge of stress hormones, such as adrenaline,
might temporarily damage the hearts of some people. How these hormones
might hurt the heart or whether something else is responsible isn't
clear.

Broken heart syndrome is often preceded by an intense physical or
emotional event. Some of the triggers of broken heart syndrome have
included news of an unexpected death of a loved one, a frightening
medical diagnosis, domestic abuse or losing a lot of money. Physical
stressors, such as an asthma attack, a car accident or major surgery,
also have been known to trigger broken heart syndrome.

How is broken heart syndrome different from a heart attack?
Most heart attacks are caused by a complete blockage of a heart artery
due to a blood clot forming at the site of narrowing from fatty buildup
(atherosclerosis). In broken heart syndrome, the heart arteries are not
blocked, although blood flow in the arteries of the heart may be
reduced.


Risk factors

Broken heart syndrome affects women far more often than men. Some
research indicates nearly nine out of 10 cases occur in women, and of
those, almost all are in women 50 or older.


Complications

In rare cases, broken heart syndrome is fatal. However, most who
experience broken heart syndrome quickly recover and don't have
long-lasting effects.

Other complications of broken heart syndrome include:

* Disruptions in your heartbeat
* A fast or slow heartbeat
* Backup of fluid into your lungs (pulmonary edema)

It's also possible that you may have broken heart syndrome again if you have another stressful event.


Preparing for your appointment

Broken heart syndrome is often diagnosed in an emergency setting, since
many people with the condition think they're having a heart attack.

If you think you may have experienced an episode of broken heart
syndrome, or are worried about your risk, make an appointment with your
family doctor.

Because appointments can be brief, and because there's often a lot of
ground to cover, it's a good idea to be prepared for your appointment.
Here's some information to help you get ready for your appointment, and
what to expect from your doctor.

What you can do

* Be aware of any pre-appointment restrictions. At the time you make
the appointment, be sure to ask if there's anything you need to do in
advance, such as restrict your diet.
* Write down any symptoms you're experiencing, including any that may seem unrelated to broken heart syndrome.
* Write down key personal information, including a family history of
heart disease, stroke, high blood pressure or diabetes, and any major
stresses or recent life changes.
* Make a list of all medications, as well as any vitamins or supplements, that you're taking.
* Take a family member or friend along, if possible. Sometimes it
can be difficult to soak up all the information provided to you during
an appointment. Someone who accompanies you may remember something that
you missed or forgot.
* Be prepared to discuss your diet and exercise habits. If you don't
already follow a diet or exercise routine, be ready to talk to your
doctor about any challenges you might face in getting started.
* Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions
will help you make the most of your time together. List your questions
from most important to least important in case time runs out. For broken
heart syndrome, some basic questions to ask your doctor include:

* What is likely causing my symptoms or condition?
* What are other possible causes for my symptoms or condition?
* What should I do if these symptoms happen again?
* What kinds of tests will I need?
* What is the best course of action?
* What foods should I eat or avoid?
* What's an appropriate level of physical activity?
* What are the alternatives to the primary approach that you're suggesting?
* I have other health conditions. How can I best manage them together?
* Are there any restrictions that I need to follow?
* Should I see a specialist? What will that cost, and will my
insurance cover seeing a specialist? (You may need to ask your insurance
provider directly for information about coverage.)
* Is there a generic alternative to the medicine you're prescribing me?
* Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor,
don't hesitate to ask questions during your appointment at any time that
you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to
answer them may reserve time to go over any points you want to spend
more time on. Your doctor may ask:

* When did you first begin experiencing symptoms?
* Have your symptoms been continuous, or occasional?
* How severe are your symptoms?
* What, if anything, seems to improve your symptoms?
* What, if anything, appears to worsen your symptoms?
* Are you depressed or stressed?
* What kind of support do you have to cope with your stress?


Tests and diagnosis

If your doctor suspects you have broken heart syndrome, he or she will use these exams and tests to make a diagnosis:

* Personal history and physical exam. In addition to a standard
physical exam, your doctor will want to know about your medical history,
especially whether you've ever had heart disease symptoms. People who
have broken heart syndrome typically don't have any heart disease
symptoms before they're diagnosed with broken heart syndrome. Also, your
doctor will want to know if you've experienced any major stresses
recently, such as the death of a loved one.
* Electrocardiogram (ECG). In this noninvasive test, a technician
will place probes on your chest that record the electrical impulses that
make your heart beat. An ECG records these electrical signals and can
help your doctor detect irregularities in your heart's rhythm and
structure.
* Chest X-ray. Your doctor will likely order a chest X-ray of your
heart to see if your heart is enlarged or has the shape that's typical
of broken heart syndrome.
* Echocardiogram. Your doctor may also order an echocardiogram to
see if your heart is enlarged or has an abnormal shape, a symptom of
broken heart syndrome. This noninvasive exam, which includes an
ultrasound of your chest, shows detailed images of your heart's
structure and function. Ultrasound waves are transmitted, and their
echoes are recorded with a device called a transducer that's held
outside your body. A computer uses the information from the transducer
to create moving images on a video monitor.
* Blood tests. Most people who have broken heart syndrome have an
increased amount of certain enzymes in their blood. Your doctor may
order blood tests to check for these enzymes to help diagnose broken
heart syndrome.

Treatments and drugs

There are no standard treatment guidelines for treating broken heart
syndrome. At first, it's treated similar to a heart attack until the
diagnosis is clear. There is no specific therapy, and most people stay
in the hospital while they recover, which takes about a week.

Your doctor will likely prescribe blood pressure medications for you to
take while you're in the hospital, such as angiotensin-converting enzyme
(ACE) inhibitors, beta blockers or diuretics. These medications help
reduce the workload on your heart while you recover. Usually, your
doctor will tell you to stop taking these medications once you recover.

Procedures that are often used to treat a heart attack, such as coronary
angioplasty and stent placement, are not helpful in treating broken
heart syndrome. These procedures treat blocked arteries, which are not
the cause of broken heart syndrome.


Prevention

There's a small chance that broken heart syndrome can happen again after
a first episode. There's no proven therapy to prevent additional
episodes; however, many doctors recommend long-term treatment with beta
blockers or similar medications that block the potentially damaging
effects of stress hormones on the heart.