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About Medicine; Dying of a broken heart

In 1964, February was designated by the Federal Government as American Heart Month. It is the month of the year that we should focus on making heart healthy choices in our lives. Unfortunately, heart disease remains the number one cause of death in both men and women around the world. Most of us are familiar with the traditional risk factors associated with heart disease. These risk factors include a history of smoking, hypertension, diabetes and high cholesterol. In addition, a family history of heart disease is considered an additional risk factor. Unfortunately, few people realize that there is also a rather significant cardiovascular risk factor that we are all, one way or another, exposed to. I am talking about the risk factor of stress.

There is no better example of how stress can affect the heart then the condition "stress cardiomyopathy". A stress cardiomyopathy has many names including "Takotsubo Cardiomyopathy", "Broken Heart Syndrome", and "Apical Ballooning Syndrome." These are different names for the same syndrome in which intense emotional or physical stress can cause rapid and severe heart muscle weakness (cardiomyopathy).

What is "stress cardiomyopathy?"

Stress cardiomyopathy is a sudden weakness of the heart that is a direct result of severe emotional or physical stress. This condition can occur following a variety of emotional stressors such as the death of a loved one, severe fear, extreme anger and even surprise. It can also result following significant physical stressors such as an acute illness like a stroke, pneumonia or even severe pain.

A different type of heart attack.

Most heart attacks are due to coronary arteries being blocked by blood clots that form after cholesterol plaque ruptures. This is different from what is seen with stress cardiomyopathy. Most patients with stress cardiomyopathy have fairly normal coronary arteries without blockages or clots. The heart muscle cells in stress cardiomyopathy are temporarily paralyzed rather than killed as occurs in a atypical heart attack.

Because there is no permanent muscle damage, the heart muscle has a better chance to return to normal function. In contrast to the commonly held belief that stress cardiomyopathy is less serious than a typical heart attack, the rates of death in hospital between stress cardiomyopathy and traditional heart attacks are similar. However, because the heart muscle is not permanently damaged in a stress cardiomyopathy, patients typically make a rapid and complete recovery. The long-term prognosis for these patients appears to be good.

Who is at risk for getting a stress cardiomyopathy?

Stress cardiomyopathy is a relatively new medical syndrome and therefore the details of who is predisposed to this condition is not entirely known. There is a significant propensity for a stress cardiomyopathy to affect primarily women. A recent study of 1750 patients with a stress cardiomyopathy revealed that 90 percent of the cases occurred in women. This study also showed the average age of those affected by this condition was 67. There seems to be a tendency towards postmenopausal woman being affected mostly. Men are rarely affected by this condition.

What are the typical symptoms of a stress cardiomyopathy?

Symptoms are very similar to those of a traditional heart attack. Symptoms include sudden onset of severe chest pain, shortness of breath, diaphoresis (sweating), nausea and symptoms of low blood pressure including dizziness and light-headedness. The symptoms usually occur soon after one experiences a sudden stress.

What is the possible mechanism of a stress cardiomyopathy?

As previously mentioned, there is usually no coronary artery disease, blockages or clots in patients with a stress cardiomyopathy. So what could possibly be the mechanism of sudden heart muscle weakness? Our bodies produce various hormones and proteins in response to stress. These hormones and proteins help us either defend ourselves or help us escape from danger (fight of flight stress response). With stress cardiomyopathy, it is thought that the heart muscle is overwhelmed by a massive amount of these stress hormones and proteins. Since most of the cases of stress cardiomyopathy occur in postmenopausal women, there is speculation that the lack of estrogen in this population may also play a role in how stress causes temporary heart muscle weakness. Unfortunately, because this is a relatively newly recognized condition, the exact mechanism is not entirely known.

How is a stress cardiomyopathy treated?

Because stress cardiomyopathy can mimic a typical heart attack, many patients may initially be treated in a similar fashion as if they were suffering from a heart attack. This includes the use of oxygen, nitroglycerin, blood thinners, and usually immediate transfer to a hospital capable of performing a coronary angiogram.

Once the diagnosis of a stress cardiomyopathy is established, treatment largely involves supportive care to help the heart muscle recover from the stress insult. These include medications to help remove fluid from the lungs, medications to help improve blood pressure which include beta blockers and Ace inhibitors, and medications to prevent blood clots and strokes. Most patients participate in a formal cardiac rehabilitation program to help facilitate complete recovery.

There is no debate that chronic stress can affect our health and well-being. Especially in the present day and age, there seems to be no shortage of stressors in our daily lives. We all have different ways to cope with our stress. Some individuals have better coping skills than others. It is the different ways that people cope with daily stressors that can have profound effects on our heart health. Interestingly, not all stress is detrimental. A certain level of stress in our lives relieves monotony, spurs people towards worthwhile goals, and at times is pleasurable, especially when we successfully accomplish a very difficult stressful task.

February is American Heart Month, let’s celebrate together! Marcus Daly Memorial Hospital and the International Heart Institute of Montana have teamed up to provide you with cardiology services at Marcus Daly Memorial Hospital and this week’s health class. Join us on Thursday, February 8, 2018 from 5:30pm to 6:30pm in the hospital’s Blodgett and Canyon View conference rooms as Anthony Navone, MD, from Marcus Daly Cardiology Services, talks about emotions, stress and heart disease. He will explain how your emotions and stress impact your heart health. You will learn about hypertension and the long term effects and risk factors for heart disease. As well as how to differentiate between controllable and non-controllable risk factors and ways to modify behavior for each of the controllable risk factors.

Anthony Navone, MD at Bitterroot Health Cardiology Center, 1200 Westwood Drive, Hamilton, MT 59840 Working together to build a healthier community!