Broken Heart Syndrome, Redux

In 2006 I first wrote of what was considered a very rare condition – Takotsubo, or broken-heart syndrome.  Now it seems it’s less uncommon – at least, in Germany.  Also known as stress-cardiomyopathy, the syndrome consists of a temporary form of acute heart failure triggered by stressful events, and associated with a distinctive EKG pattern.  A series of 256 patients with Takotsubo syndrome has been analyzed, and the results reported in the Journal of the American Medical Association.      

Data on the patients came from 7cardiaccenters in Rurope and Nporth Am,Erica from 2005 to 2010.  Over 80% of the patients were postmenopausal women, 8% were women under 50, and 11% were men.  A stressful trigger to the condition was identified in 71%.  An important finding: 88% of the patients reported symptoms that were consistent with acute coronary syndrome – the chest pain felt during a heart attack, or while at rest or doing light physical activity (also known as unstable angina), due to impaired oxygen supply to heart muscle. 

A useful tool for distinguishing stress cardiomyopathy from acute coronary syndrome is cardiac magnetic resonance imaging (cardiac MRI).  It can reveal distinctive patterns of ballooning of the cardiac ventricles: at the tip or apex, in both ventricles, at mid-ventricle, and at the ventricle base.  Apical is the most common location (seen in 82%).  Those patients with ballooning involving both ventricles were more likely to have had previous stressful events, and required an extra couple of days in hospital; they were also more likely to develop a pleural effusion (‘fluid on the lung’).

An important feature of stress cardiomyopathy is absence of coronary heart disease.  However, there was impaired heart function.  The left ventricular ejection fraction was reduced, averaging 48% (normal values are 50% to 70%), but there was complete normalization of the fraction subsequently, so long as there was no evidence of cardiac fibrosis.  Most subjects (81%) had visible evidence of myocardial edema.

Four patients died in hospital (1.4%), two from ventricular fibrillation, one from cardiogenic shock, and one from low-oxygen brain injury.  Clearly, stress cardiomyopathy, or broken-heart syndrome, or Takotsubo, or whatever you call it, is more common than we supposed, but also emerging as a non-fatal condition.  This shouldn’t deter anyone with chest pain, weakness, and anxiety, from going to the ER in the hope that it’s Takotsubo rather than life-threatening acute coronary syndrome.  Both conditions must be taken seriously and treated by a cardiology team.

Comments

[GV]

This is very informative post thanks for sharing about broken-heart syndrome.I like to read about it more.
(edited RG)