Broken-Heart Syndrome

Broken Heart Syndrome: description

Broken Heart Syndrome is a sudden, high-stress left ventricular dysfunction triggered by severe stress. They are among the primary acquired heart muscle diseases (cardiomyopathies).

So it affects only the heart and is not innate, but occurs in the course of life. Other names for the disease are stress cardiomyopathy and Tako-Tsubo cardiomyopathy or Tako-Tsubo syndrome.

Most Broken Heart syndrome is initially thought to be a heart attack because it causes the same symptoms. In the big difference, however, there is no closure of a coronary artery in those affected. Although Broken Heart Syndrome is less life threatening than a heart attack, serious complications can still occur.

Who is affected by Broken Heart Syndrome?

Tako-Tsubo cardiomyopathy was first described in the 1990s and has since been studied only in small groups of patients. Therefore, there are still no large amounts of data that could be used to determine the frequency and distribution of the disease.

However, Broken Heart syndrome is much more common in women than in men. In many cases it is older women after the menopause. At first it seemed that this form of heart muscle disease was occurring mainly in Asia, but now it has been observed worldwide.

It is estimated that two percent of all patients, and as many as 7.5 percent of women admitted to hospital for suspected heart attacks, have broken heart syndrome.

Broken Heart Syndrome: Symptoms

The symptoms of a broken heart syndrome are indistinguishable from those of a heart attack. Those affected suffer from shortness of breath, feel a tightness in the chest and sometimes even have the strongest pain, which is also known as annihilation pain. Often the blood pressure drops, the heartbeat accelerates and there are sweats, nausea and vomiting.

Due to the functional impairment of the heart, complaints of heart failure often occur. For example, the blood builds up in the lungs and venous vessels because it can not be sufficiently pumped into the circulation by the heart. The result may be fluid retention (edema) in the lungs and especially in the legs.

complications

Although the mechanism that leads to the symptoms is completely different from that of a heart attack, Broken Heart Syndrome can also be associated with serious, sometimes life-threatening, complications. For example, in a small proportion of those affected massive cardiac arrhythmias occur, which in the worst case trigger a sudden cardiac death.

In case of pronounced pumping weakness of the heart, a so-called cardiogenic shock can also develop. The blood pressure then drops so much that the body is no longer supplied with sufficient oxygen. Without timely treatment, this complication is often fatal.

Broken Heart Syndrome: Causes and Risk Factors

In most cases, the Broken Heart syndrome is preceded by a great emotional burden. This can be, for example, separations or the death of a loved one, which explains the name of the disease. Traumatic events such as natural disasters or violent crimes, as well as life-threatening situations, such as job losses, are possible triggers.

Recent studies have also shown that even positive stress can cause Tako-Tsubo cardiomyopathy. Joyful events such as a wedding, a birthday or a lottery win are therefore also possible reasons for this form of heart muscle disease, albeit much less frequently than negative stress.

How exactly an emotional burden leads to a dysfunction of the heart muscle and the physical symptoms of a heart attack, is not yet fully understood. However, many patients with Broken Heart syndrome experience elevated levels of certain stress hormones in the blood.

For example, so-called catecholamines such as adrenaline and norepinephrine are increasingly released by the body. Researchers suspect that the stress hormones act on the heart muscle and lead there to circulatory disorders and cramps.

Female sex hormones (estrogens) have a protective effect on the heart. As their concentration in the blood decreases after the menopause, this is a possible explanation for the fact that especially older women are affected by a Broken Heart syndrome.

Broken Heart Syndrome: Examinations and Diagnosis

Since it is initially not possible to distinguish a Broken Heart syndrome from a heart attack, it is always assumed in a patient with the corresponding symptoms of a heart attack. Therefore, a doctor must perform a comprehensive diagnostic as soon as possible, with the help of which he can detect or rule out a heart attack.

A Broken Heart syndrome shows some similar results in the examinations, but also shows significant differences:

echocardiography

Ultrasound examination of the heart (echocardiography) usually reveals a typical movement disorder of the left ventricle in the area of ​​the apex of the heart in Broken Heart Syndrome. The musculature appears there very little mobile (Akinese). Thus, the alternative name of the disease came about:

At the end of the heartbeat (Systole), the heart looks like a pitcher with a short neck. This shape is reminiscent of a Japanese octopus trap called “Tako-Tsubo”.

As a result of the often resulting heart failure can be detected by means of echocardiography also often a fluid accumulation in the lungs. A heart attack can present itself in a similar way and therefore can not be ruled out on the basis of echocardiography alone.

Electrocardiogram (ECG)

Also on the ECG, the curve in stress cardiomyopathy is similar to a heart attack. Namely, there are changes in the electrical heart activity, as they are typical for a hypoxia of the heart muscle. However, these changes usually show up in all the curves (leads) of the ECG and not just for a specific heart muscle area, as is usually the case with a heart attack.

blood values

As in the case of a heart attack, the concentrations of certain enzymes such as troponin T or creatine kinase (CK-MB) in the blood rise after a few hours. However, the climbs are usually lower than during infarction.

angiography

This procedure can be used to show if and how well the various coronary arteries are perfused. While one or more coronary arteries are blocked in a heart attack, in a Tako-Tsubo syndrome there is no closure of a coronary artery. Angiography is therefore a good way to differentiate between the two diseases.

Magnetic Resonance Imaging (MRI)

Special MRI techniques (cardiac MRI with stress MRI) can also be arranged by the doctor. With these methods, he can detect circulatory and movement disorders of the heart muscle and simultaneously represent scarring of the muscles, which would be typical of a past heart attack.

patient consultation

In an interview with patients with acute heart problems, the doctor is particularly interested in the symptoms and whether the event was preceded by an intense emotional stress situation. If this is not the case, Broken Heart Syndrome is unlikely.

Broken Heart Syndrome: Treatment

There is currently no single scheme for the treatment of Tako-Tsubo cardiomyopathy. Because it can lead to life-threatening complications, especially in the first few hours, one should monitor the patients for some time in an intensive care unit.

The effects of stress hormones can relieve certain medications such as alpha or beta blockers. They reduce the heart burden. Also cardiac arrhythmias and any symptoms of heart failure can be treated with appropriate drugs.

Broken Heart Syndrome: disease course and prognosis

Of all myocardial diseases, Tako-Tsubo cardiomyopathy has the best prognosis. Often the symptoms go back in the first hours. Only rarely do complications or permanent damage to the heart arise.

In most patients, heart function returns to normal after a few weeks. The Broken-Heart Syndrome then heals without further consequences.