Q: What is a broken heart syndrome?

Broken heart syndrome (BHS) is a transient condition that affects the heart and in the majority of instances it is a consequence of overwhelming emotional, or severe physical stress. The function of the heart’s left lower chamber (left ventricle) is exclusively compromised and the sufferer may report symptoms similar to someone having a heart attack.

Broken heart syndrome may also be referred to as: Takotsubo cardiomyopathy (TCM)
Stress cardiomyopathy
Apical ballooning syndrome

Once a timely diagnosis is made, BHS is treatable with the heart returning to its normal function within weeks to months with no long-term complications. Only in rare circumstances, it can result in death.

It is suspected that an elevation of the stress hormones, specifically adrenaline, and noradrenaline, may result in excessive constriction of the arteries supplying the heart (coronary) and temporary damage to the heart muscle (myocardium).

Symptoms

Persons suffering from BHS often report the following after an emotionally or physically stressful event:

• A tightness, pain, ache, squeezing, and/ or weight-like sensation in the chest which may radiate to their jaw, arms, and or back.
• Shortness of breath
• Dizziness and or lightheadedness
• Cold sweats
• Extreme tiredness
• Heartburn, upper abdominal pain, nausea, or indigestion

Causes of BHS:

In 75% of cases, the precipitant of a BHS is some form of stress. Emotional stressors may include:

• Death of a loved one/ beloved pet
• Significant loss – e.g: divorce, relationship break-up, job, home
• Extreme anger
• Fear – e.g. robbery, accident
• Surprise – e.g. winning a lottery

Physical stressors include:

• Major illness
• High fevers
• Very low blood sugar
• Some medications used to treat anaphylaxis (severe allergic reactions)
• Methamphetamine
• Cocaine
• Nasal decongestants
• Potential complications of a BHS
• Heart failure
• Shock as a result of severe low blood pressure
• Abnormalities in the heart’s rhythm
• Death in approximately 1%

Those at greatest risk for a BHS

• Women represent about 88% of the cases
• Those over the age of 55
• Persons who previously suffered from anxiety, depression, or neurological disease

Diagnosing a BHS

The initial step to diagnosing a BHS starts with the clinician having a high index of suspicion. After a detailed history and clinical examination the doctor may opt to carry out the following tests on the patient in order to rule in or out the diagnosis of a BHS:

• Electrocardiogram (ECG or EKG)
• Echocardiogram
• Cardiac enzyme blood tests
• Coronary angiogram – where available
• Cardiac magnetic resonance imaging (cardiac MRI) – where available
• Treatment options for persons with BHS

The treatment given depends on the severity of the BHS, however treatment is generally supportive for BHS is self limiting. Treatments may include:

• ACE inhibitors
• Beta-blockers
• Diuretics
• Anti-anxiety medications

Outlook

The in-hospital survival rate for BHS is approximately 99% once the patient is ushered through the initial and acute phase of this condition. Improvement in heart function is normally seen within the first few days of treatment and full resolution within weeks to months of initial presentation. While relapses have been reported these are rare.

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale, www.familycaresvg.com, clinic@familycaresvg.com, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)
Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.