Broken heart syndrome

Broken hearts

Laynie Kelly was 40 when her heart broke. Early on a wet Saturday morning in July 2001, her husband of 13 years, Jim, passed away after a gruelling battle with cancer. Laynie was understandably devastated. “I spent the day flooding my house with tears,” she recalls. It was only as she got into bed that night that she noticed she had chest pain.

“The first time I registered it [the pain] – and it was quite intense – was when I was actually trying to get to sleep.” She says the pain “went literally from…the middle of my breastbone, right across my heart, right down to my left shoulder and stopped at the elbow.”

After trying unsuccessfully to ease the pain, a friend drove her to the emergency department at 2am. “I walked in and said, ‘Hi, I think I’m having a heart attack,’” Kelly says.

“They put me straight on the heart monitors and all the machines that whiz, bang, whirl and tweet.”

She had been in hospital for about five hours when the doctor informed her of his suspected diagnosis. Her blood tests had comeback normal and there were no signs of long-term damage. “He said, ‘I just think you’ve got a bad case of really, really broken heart,’” she recalls.

Initially, Kelly dismissed the idea as metaphor. “I always thought that was something fictional, but I have [since] heard different stories of people having similar stories, so it medically can actually happen,” she says.

In fact, broken heart syndrome, or Takotsubo cardiomyopathy as it was originally labelled, is a medical condition first described by the Japanese in the 1990s. Sufferers experience heart changes most commonly caused by an extreme life event such as the death of a loved one. It can also occur after a stressful, though positive, experience such as after a wedding or winning a large sum of money.

Dr Clara Chow, a cardiologist at Westmead Hospital and head of the cardiac program at The George Institute for Global Health, says that family-related stress (especially losing a family member) is a common precipitant.

“So the classical thing is people have experienced a high amount of stress and the develop this sudden onset heart failure caused by a cardiomyopathy [enlarging of the heart],”explains Dr Chow. She says there’s “not a lot of good understanding” about why it occurs,but emphasises it has a “clear-cut” association with stress.

While the cause is not well understood, research at the University of Arkansas found that women are 7.5 times more likely to have their hearts ‘broken’ than men.

One hypothesis is that women are more emotional than men, hence more likely to experience severe stress in relation to their emotions. Dr Chow says, “Men get emotional stress as well, but you just don’t see it [broken heart syndrome] in men that often. I’ve seen it a number of times in women, [yet] I don’t think I’ve ever even seen a case in a male, which is odd. [But] I’m sure it happens.”

Another theory relates to the number of adrenaline receptors located on the heart. This theory postulates that men have more of these receptors, so can ‘handle’ more stress on their hearts than women. However, Dr Chow says these theories are not proven.

Regardless of the cause, the effect on the heart is the same. The apex (end of the heart) becomes temporarily enlarged. According to Dr Chow, this can cause the patient to feel chest pain or breathlessness, symptoms that can also occur during a heart attack.

Because heart attacks occur more commonly and can have more serious implications than broken heart syndrome, Dr Chow advises seeking medical attention for these symptoms. After all, the two conditions are indistinguishable to the sufferer, and heart attacks require urgent treatment.

Not only is it difficult for patients to tell the difference between these conditions, Dr Chow says it can be hard for doctors to do so as well. It is only on further investigation that the differences between the conditions emerge.

Firstly, unlike a heart attack, there are no underlying blocked arteries in broken heart syndrome. According to Dr Chow, the pattern of heart enlargement is also different. “It’s a very characteristic pattern and doesn’t fit with blockage of a single vessel, which is what would happen in a heart attack,” she says. She notes the appearance of the heart on ultrasound further helps identify this condition.

And though a heart attack usually leads to permanent heart damage, with broken heart syndrome the heart usually returns to normal.

When patients arrive at hospital, “They can have quite a badly damaged heart,” says Dr Chow. “But usually six or 12 months later they’ll get quite a lot of improvement. So they usually do well.”

Kelly also recovered from her episode of broken heart syndrome fairly quickly. “The actual intense pain, that ripping pain in my heart…went away within a day or so,” she says. And although she never suffered from this condition again, 10 years later she says her heart is still broken. “The actual heartache pain stopped but the ache of losing my husband still hasn’t.”


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