Creative Commons, Csar13
Source: Creative Commons, Csar13

The New England Journal of Medicine on October 19, 2017, reported on the case of a woman who suffered from broken heart syndrome after the death of her dog. Although we often read about people who die of a broken heart, in fact, broken heart syndrome has been considered a temporary condition is also known as stress-induced cardiomyopathy or Takotsubo cardiomyopathy.  The pain can be so severe that it mimics a heart attack and often sends those affected to a hospital's emergency department as was this recent case.  

Discussed here is the woman treated for severe chest pain as well as the science, symptoms, and recovery from a condition which most often affects those who have lost a love relationship. Additionally, there is research noting that there may be long-lasting damage to the heart muscle.

Regarding Takotsubo cardiomyopathy NEJM noted:

"A 61-year-old woman with hypertension and hypothyroidism presented to the emergency department with acute onset of severe chest pain. She reported multiple recent stressors, including the death of her dog. . . .

"Medical management, including the administration of an angiotensin-converting–enzyme (ACE) inhibitor and a beta-blocker, was initiated, and the patient’s chest pain resolved. An echocardiogram obtained 1 month after presentation showed normalization of cardiac wall motion and an ejection fraction of 65 to 70%. At follow-up 1 year after presentation, the patient remained asymptomatic."

Although we most often hear of the broken heart syndrome with regard to a failed romance, as we learned last week, it can even occur when someone suffers from the loss of their pet.

Long-term heart muscle damage

What follows is from my June 19, 2017, post regarding recent research from the University of Aberdeen, Scotland, where it was determined that the broken heart syndrome may not be temporary,  it can cause long-lasting damage to the heart muscle as reported in Journal of the American Society of Echocardiography on June 10, 2017.

Stress cardiomyopathy is also known as Takotsubo cardiomyopathy, named after an octopus trap. It primarily affects women and is often described as being a non-threatening condition.

However, the new Aberdeen University study, which underscores a need for more research, says:

In patients with the most clinically severe spectrum of takotsubo cardiomyopathy, regional LV [left ventricle] systolic and diastolic deformation abnormalities persist beyond the acute event, despite normalization of global LV ejection fraction and size. In addition, although myocardial edema partly subsides, a process of global microscopic fibrosis develops in its place, detected as early as 4 months.

Pain and Symptoms

The heartbreak pain is triggered by a hormone rush that a woman experiences after the loss of a loved one, a traumatic ending to a love affair, or even a divorce. This adrenaline surge interferes with the heart’s pumping ability, sending it into a freeze mode and leaving the left ventricle enlarged as depicted in the Harvard Health Letter, which states:

"Stress cardiomyopathy feels like a heart attack—pain in the chest, left arm, jaw, or upper back; feeling short of breath or lightheaded; the sudden onset of nausea, dizziness, or a cold sweat. It even looks like one on an electrocardiogram. But none of the coronary arteries are blocked, the hallmark of a heart attack." ​Science Behind Broken Heart Syndrome

Heart Attack Risk After Death of a Loved One

What about all of those stories we read of a spouse who dies within weeks or months after losing a husband or wife? This type of heartache seems to be unique to bereavement, particularly among elderly couples who have lived a long married life together.

Dr. Elizabeth Mostofsky is a postdoctoral fellow in the cardiovascular epidemiology research unit at Beth Israel Deaconess Medical Center in Boston and instructor at Harvard School of Public Health.  In an earlier interview, she explained to me that after the death of a loved one, the heart-attack risk is 21 times higher within 24 hours.

Although the risk diminishes each day thereafter, it remains elevated over several months. Mostofsky and her team reached their conclusions after interviewing almost 2,000 patients who suffered myocardial infarctions over five years and reported their findings in Circulation, the Journal of the American Heart Association.

Dr. Mostofsky says signs of bereavement involve “increased feelings of depression, anxiety and anger, and those have been shown to be associated with increases in heart rate, blood pressure and a tendency for blood clotting — all of which can lead to a heart attack.”

While social support and medication may mitigate serious consequences of a heart attack after bereavement, can stress cardiomyopathy be alleviated?

How to Protect Yourself

If there is any way to avoid the broken heart syndrome, it might be helpful for a woman to surround herself with supportive friends after a break-up. A preventive approach might include coming to terms with the relationship, understanding the symptoms of depression, and seeking professional help.

While many women in difficult relationships believe they can “work things out,” depression must be taken seriously. Finding help in a therapist's office rather than the emergency room is an option worth considering.

The key question remains: Can you die from a broken heart? The answer is both yes and no. “Yes,” during bereavement it is possible to have a fatal event, but with regard to the broken-heart syndrome, the answer most often is “no.”

While it may take time, keep in mind that it is possible to recover from the sadness of lost love. Here are some thoughts:  Rebound Love: 10 Tips for Healing a Heart after a Breakup.

References

Abhishek Maiti, M.B., B.S.Abhijeet Dhoble, M.D., "Takotsubo Cardiomyopathy" N Engl J Med 2017; 377:e24October 19, 2017DOI: 10.1056/NEJMicm1615835

Konstantin Schwarz, Trevor Ahearn, Janaki Srinivasan, Christopher J. Neil, Caroline Scally, Amelia Rudd, Baljit Jagpal, Michael P. Frenneaux, and others, "Alterations in Cardiac Deformation, Timing of Contraction and Relaxation, and Early Myocardial Fibrosis Accompany the Apparent Recovery of Acute Stress-Induced (Takotsubo) Cardiomyopathy: An End to the Concept of Transience" Journal of the American Society of Echocardiography, Published online: June 13, 2017 (Publication stage: In Press Corrected Proof)

Kevin A. Bybee, MD; Abhiram Prasad, MD, FRCP, FESC, "Stress-Related Cardiomyopathy Syndromes, Contemporary Reviews in Cardiovascular Medicine," Circulation. 2008; 118: 397-409

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