link May 25, 2005
News this month
Broken heart syndrome mimics heart attacks
Researchers at Johns Hopkins Hospital in Baltimore have found that emotional trauma can result in the release of hormones that can “stun” the heart, mimicking the symptoms of a heart attack. Stress cardiomyopathy or “broken heart” syndrome, long a subject of folklore, has been observed primarily among women who have undergone extreme stress such as the death of a loved one or a car accident.
Emotional trauma can result in the release of hormones that can “stun” the heart, mimicking the symptoms of a heart attack.
Individuals who experience this syndrome have chest pain, shortness of breath, fluid in the lungs and heart failure. The heart's ability to pump is severely impaired, but the heart tissue itself is not damaged as in a heart attack. “The tissue is alive,” says Dr. Hunter Champion who co-authored the study published in the New England Journal of Medicine.
Study reveals unique patterns, but no disease
Champion and fellow Hopkins cardiologist Ilan Wittstein had observed that a small number of heart attack patients, usually postmenopausal women, had unique electrocardiograms and ultrasound patterns and no evidence of coronary artery disease. They recovered quickly from their attacks, which had been preceded by intense emotional events.
Between 1999 and 2003, the researchers studied 19 patients who had what appeared to be traditional heart attacks after experiencing sudden emotional stress, including news of a death, a surprise party, presence at an armed robbery and a car accident. Most of the patients were in their 60s and 70s although one was 27. All but one were female.
All of the subjects were evaluated with electrocardiography, cardiac enzyme assessment, echocardiography and coronary angiography. Five patients underwent a biopsy and another five had MRIs to determine if there had been damage to the heart muscle.
Stress hormones were two to three times greater than those in classic heart attack patients and between 7 and 34 times greater than in healthy people.
Similarities to classic attack not complete
Although the symptoms were similar to a classic heart attack, the similarities ended there. Stress hormone levels were measured shortly after admission and compared with readings taken at day 3, 5, 7 and 9 after the event. The initial levels of these stress hormones, called catecholamines, were two to three times greater than those in classic heart attack patients and between 7 and 34 times greater than in healthy people.
Also, unlike heart attack sufferers there was no evidence of blockages in the arteries supplying blood to the heart. Blood tests showed only mild elevation of muscle proteins typically released after a heart attack. MRI imaging showed none of the emotionally stressed patients suffered any permanent damage to their hearts. There were also very rapid improvements in the pumping ability of their hearts within a few days, and they were completely recovered within two weeks, compared to heart attack victims whose recovery normally takes months.
“Broken hearts” require treatment
It is important, the doctors stress, to treat the symptoms of broken heart syndrome. Three of the 19 patients temporarily required a special balloon in the aorta to help the heart pump better. Broken heart syndrome usually requires only short-term treatment because the heart normally recovers by itself.
Second study confirms the effect of stress hormones
Stress cardiomyopathy has been known for several years in Japan, but it has gone relatively unrecognized in the West, according to Dr. Barry Maron, a cardiologist at the Minneapolis Heart Institute Foundation. Maron described 22 similar cases in Circulation.
“Our hypothesis is that massive amounts of these stress hormones can go right to the heart and produce a stunning of the heart muscle that causes this temporary dysfunction resembling a heart attack,” Wittstein said. “It doesn't kill the heart muscle like a typical heart attack, but it renders it helpless.” It is important to support the heart during this vulnerable period otherwise patients may die.