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Broken Heart Syndrome

“Oh, this is the big one! You hear that, Elizabeth?! I’m coming to join you, honey!” This was the classic, often-repeated line voiced by Fred Sanford in the sitcom “Sandford & Son, a long time ago. Nearly every episode, if he was stressed out or not getting his way, Fred (Redd Foxx) would clutch his chest dramatically, look up to heaven, and utter that line.

There is no doubt that emotional stress can trigger angina (heart pain, usually from blocked arteries) or even a heart attack. But what’s stranger is that it can occasionally cause a similar result in people with no artery blockage at all.

Recently, one of my patients, a woman in her 60’s was in the midst of heavy emotional stress as well as a physically painful nerve condition. As she was driving home she began to experience crushing chest pain and headed straight for an emergency room. Sure enough, her EKG showed the changes typical of a heart attack, and her blood samples showed the cardiac enzyme changes typical of heart damage as well. But oddly enough, when she went for a cardiac catheterization, her arteries were clean and open with no signs of the kind of artery-blocking plaque that normally leads to a heart attack. My patient’s diagnosis: Broken Heart Syndrome (BHS), or much less memorably, Takotsubo cardiomyopathy (TCM).

BHS is a temporary cardiac condition in which the left ventricle (the main pumping chamber of the heart) enlarges and stops pumping efficiently, causing symptoms that mimic a heart attack. It’s thought that BHS is brought on by the heart’s reaction to a surge of stress hormones, possibly causing spasm of some of the coronary arteries. The symptoms are treatable, and the condition usually reverses itself in about a week. Nearly 95% have a full recovery in 4-8 weeks. Emotional or physical stressors that may trigger BHS include events such as learning of a death of a loved one, bad financial news, legal threats, natural disasters, motor vehicle accidents, a newly diagnosed, significant medical condition, surgery, the use of or withdrawal from illicit drugs (especially cocaine or methamphetamine), or any number of other major life events.

Roughly 2% of patients who had suspected heart attacks or acute angina episodes are subsequently diagnosed with BHS. Patients are typically Asian or Caucasian. Interestingly enough, nearly 90% of reported cases involve older women with an average age of 67. However, there have also been some rare cases in children and young adults.

BHS is another reminder that our emotional lives are intricately tied in with our physical lives. A biblical proverb says, “A joyful heart is good medicine, but a broken spirit dries up the bones.” It turns out a stressed out life really can occasionally break the heart.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835

 

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