Last week, just in time for Valentine's Day, almost every newspaper in the country sported the breathless headline, "You Really Can Die From a Broken Heart." The attached stories talked, in somewhat vague terms, about a condition in which people (usually women) had acute cardiac symptoms and almost died from heart failure following an episode of emotional stress.
This story comes from two scientific papers published this month, in the medical journals Circulation and the New England Journal of Medicine, describing a total of 41 patients (40 of them women) with this new syndrome. In this syndrome, which investigators are calling "stress cardiomyopathy," women experience some sort of sudden emotional trauma (examples included news of a death, armed robbery, and a surprise party,) and subsequently develop symptoms suggesting an acute heart attack (severe pressure-like chest pain, shortness of breath, and a sense of impending doom.)
When they arrive in the emergency room, they are initially thought to be having massive heart attacks. However, the changes on their ECGs are not typical for a heart attack, and the cardiac enzyme tests that are supposed to confirm a heart attack are found not to not elevated. Furthermore, when taken to the catheterization laboratory, their coronary arteries are found to be normal (whereas in true heart attacks, one of the coronary arteries would have been completely occluded.) And finally, many of these patients are found to have a peculiar type of heart muscle weakness (or cardiomyopathy) on echocardiography, where the apex of their left ventricle "balloons" outward. Many of these patients are in severe heart failure initially, and require aggressive and intensive cardiac care. With appropriate care, however, not only do they survive, but also their cardiomyopathy completely resolves within a few days.
The unique features of this stress cardiomyopathy syndrome are that it occurs in otherwise healthy patients (usually women,) the onset is sudden and follows an episode of emotional stress; the presenting symptoms strongly suggest a heart attack, and patients are critically ill with cardiomyopathy; but with appropriate care they survive and the cardiomyopathy disappears in short order.
The cause of stress cardiomyopathy is unknown, but early speculation blames it on an unusual response to the release of stress hormones (such as adrenaline) after emotional trauma. Whether stress cardiomyopathy may be related to the fact that women can develop disorders of the microvessels (tiny vessels within the heart muscle itself,) such that these blood vessels can suddenly constrict under certain stressful conditions, has not been evaluated. ( See Cardiac Syndrome X.)
This stress cardiomyopathy syndrome has been written about for many years in Japan (where it is called "octopus trap cardiomyopathy" because of the peculiar shape of the ballooning heart muscle,) but until these two new research papers were published it has been virtually unknown in the rest of the world.
DrRich Comments:
The term "broken heart syndrome" is probably not a particularly accurate one here. DrRich thinks of a broken heart as something that occurs after receiving a Dear John letter, rather than something that happens after seeing a loaded .44 magnum shoved in one's face. Nonetheless, this terminology has resulted in lots of publicity and the knowledge of this new syndrome consequently has been rapidly and widely disseminated. And that widespread awareness is good.
The symptoms of stress cardiomyopathy are so severe (as we now understand this syndrome) that it is inconceivable that any woman who develops it will fail to seek medical help; and the physical manifestations of the condition are so obvious that no doctor who sees one of these women could fail to realize that something serious is going on. So, as bad as stress cardiomyopathy is, at least there is little danger it will be ignored either by its victims or by medical personnel.
This stands in stark contrast to several other cardiac conditions experienced by women that are far more frequent than stress cardiomyopathy. Chief among these are angina and heart attacks - conditions that are as frequent and as dangerous in women as in men, but that often present with "atypical" symptoms. So, women who suffer from coronary artery disease often fail to seek help, and when they do seek help they often fail to get it from their doctors.
Perhaps the publicity around this "broken heart" syndrome will draw women's and doctors' attention to the general fact that heart disease in women is different than heart disease in men - but is no less frequent and no less lethal. If so, the inaccurate terminology used throughout the mass media will turn out to have been a good thing.
