BBC Medical Science — US researchers studied 70 patients with “broken heart syndrome”, a
recognised condition linked to stressful or emotional events. All these patients recovered, most after being given aspirin or heart drugs, even though 20% were deemed critically ill. The American Journal of Cardiology study says the condition is caused by a surge in stress hormones.
Six patients presented with heart-induced shock and three had abnormal heart rhythms which required emergency treatment. Two-thirds
of the patients - almost all post-menopausal women - had experienced a
very stressful physical or emotional event just before arriving at the
hospital with heart attack-like symptoms.
Overall, the
majority of those in the registry were prescribed aspirin or heart
drugs such as, beta blockers, ACE inhibitors and statins while in
hospital. Even though a fifth were were critically ill
and required emergency treatment to keep them alive, all the patients
survived the first 48 hours and experienced a full recovery.
The
researchers also discovered that, unlike heart attacks which tend to
occur in winter, broken heart syndrome cases tend to occur in the
spring and summer months.
An earlier study of 19 patients at John Hopkins Hospital was published in the New England Journal of Medicine in 2005. The authors of that study explained:
Shocking news, such as learning of the unexpected death of a loved one, has been known to cause catastrophic events, such as a heart attack. Researchers at Johns Hopkins discovered that sudden emotional stress can also result in severe but reversible heart muscle weakness that mimics a classic heart attack. Patients with this condition, called stress cardiomyopathy but known colloquially as “broken heart” syndrome, are often misdiagnosed with a massive heart attack when, indeed, they have suffered from a days-long surge in adrenalin (epinephrine) and other stress hormones that temporarily “stun” the heart.
Hopkins’ researchers collected detailed histories
and conducted several tests, including blood work, echocardiograms,
electrocardiograms, coronary angiograms, MRI scans and heart biopsies,
on a total of 19 patients who came to Hopkins between November 1999 and
September 2003. All had signs of an apparent heart attack immediately
after some kind of sudden emotional stress, including news of a death,
shock from a surprise party, fear of public speaking, armed robbery, a
court appearance and a car accident. Eighteen of the stressed patients
were female, between the age of 27 and 87, with a median age of 63.
The results were then compared to seven other patients, all of whom had
suffered classic, severe cases of heart attack, called a Killip class
III myocardial infarction.
When
results from both groups were compared, the researchers found that
initial levels of catecholamines in the stress cardiomyopathy patients
were two to three times the levels among patients with classic heart
attack, and seven to 34 times normal levels.
Catecholamine
metabolites, such as metanephrine and normetanephrine, were also
massively elevated, as were other stress-related proteins, such as
neuropeptide Y, brain natriuretic peptide and serotonin. These results
provided added confirmation that the syndrome was stress induced.
Heart biopsies also showed an injury pattern consistent with a high
catecholamine state and not heart attack.
A similar syndrome, known medically as Takotsubo cardiomyopathy, was first
described by Japanese researchers in the early 1990s. But no biochemical analyses were performed that might have linked the condition to elevated
catecholamine levels.
The researchers contend that while stress
cardiomyopathy is not as common as a typical heart attack, it likely
occurs more frequently than doctors realize. They expect its numbers
to increase as more physicians learn to recognize the syndrome’s unique
clinical features, and as our lives become more stressful. (04/01/09)
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