How can you mend a broken heart?

Resource post for April

“…and….how can you mend a broken heart?…How can you stop the rain from falling down?…How can you stop the sun from shining…What makes the  world go round?”

goes the 70s hit of the Bee Gees though it’s highly probable that very few of our readers know who the Bee Gees are. Nevertheless, the song was successfully revived in the romantic film “Notting Hill.” And if you haven’t heard of the film, then you must be really young!

Needless to say, mending a broken heart is not as impossible as the song purported it to be. At least when we talk about the “broken heart syndrome“, a medical condition which I tackled in a previous post last Valentine’s Day. And no, this is not an April Fool’s joke. There is really such a thing although it goes by a lot of other names, e.g. stress cardiomyopathy, stress-induced cardiomyopathy or apical ballooning syndrome in doctor speak.

But new data indicates that doctors may not be that far in finding a way in mending a broken heart. Originally known as Takotsubo cardiomyopathy in doctor speak, broken heart syndrome was named after “a type of pot used by Japanese fishermen to capture octopuses. When doctors take X-ray images of a person who’s experiencing broken heart syndrome, part of his or her heart resembles the pot.”

Studying a broken heart

Researchers at the Miriam Hospital and Rhode Island Hospital created a registry of 70 patients diagnosed between July 2004 and April 2008. About 67% of the patients on the Rhode Island Takotsubo Cardiomyopathy Registry were “mostly postmenopausal women who had experienced a very stressful physical or emotional event just before arriving at the hospital with heart attack-like symptoms.” The symptoms included angina pectoris (chest pains) and dyspnea (shortness of breath). About 20% were in critical condition and needed emergency treatment such as cardiac catheterization in order to survive. However, all patients lived through the first 48 hours which are usually critical in such cases. All were diagnosed with broken heart syndrome during the hospital stay. All eventually made a full and complete recovery.

What causes a broken heart?

“Broken heart syndrome was first described by Japanese researchers in the early 1990s. Symptoms typically mimic a heart attack and tend to follow exposure to an intense physical or emotional event. Experts believe these symptoms may be brought on by the heart’s reaction to a surge of stress hormones, like adrenaline, causing a part of the heart to temporarily weaken or become stunned (cardiomyopathy), although the exact mechanism is unknown. However, it appears that broken heart syndrome is temporary and completely reversible.”

The events that can cause thy syndrome are those which illicit strong emotional distress such as a family tragedy, bereavement, domestic dispute, or physically stressful events such as a car accident

Correct diagnosis of the broken heart syndrome in an emergency room situation is very difficult. Researchers have identified a wide range of symptoms and severity among patients in the study registry.

“Six patients presented with cardiogenic shock and three patients experienced sustained ventricular arrhythmias, requiring emergency defibrillation or cardioversion. Overall, the majority of those in the registry were prescribed aspirin, beta blockers, ACE inhibitors and statins during their hospitalization, consistent with treatment protocol for patients with acute coronary syndrome. Similarly, most patients left the hospital on a cardiac regimen very similar to that prescribed for heart attack patients.”

What we know and do not know about broken hearts

The study results gave new insights into clinical characteristic and outcomes of broken heart syndrome. Some of the findings are:

• The syndrome is relatively rare and potentially life threatening but shouldn’t be fatal as long as proper emergency medical treatment is given, including medications, respirators and other critical devices in the first 48 hours after onset of symptoms.
• The weakening of the heart muscles is temporary and reversible. Broken heart syndrome does not cause permanent and long-term damage to the heart muscles.
• There seems to be a seasonality factor involved. The majority of cases occurred during the spring and summer months in contrast to coronary heart attacks which usually occur during winter. The mechanism behind the syndrome´s seasonality is not known.
• Long-term prognosis seems very positive from a cardiac standpoint. Only two patients had recurring cases of broken heart syndrome. The majority of the patients did not show any cardiac problems during a 4-year follow up.

What the sceptics say

Despite these findings, broken heart syndrome remains controversial. Is there really such as a thing as broken heart syndrome? According to Dr. Richard Regnante, lead author of the study

“Some believe it is simply a form of a heart attack that ‘aborts’ itself early and therefore doesn’t leave any permanent heart muscle damage. Others say that the syndrome has nothing to do with the coronary arteries and is simply a problem with the heart muscle. “Since the seasonal pattern of broken heart syndrome that we observed is opposite of what it seen with heart attack patients, our findings suggest – but certainly does not prove – the latter theory may be correct.”

The findings are published in the April 1 issue of the American Journal of Cardiology.

What next?

The researchers are not stopping there.

They are currently enrolling patients with broken heart syndrome in new study. Using the imaging technique intravascular ultrasound (IVUS) during cardiac catheterization, they will try to uncover what is going on during the attack, e.g. a minor blood clot, a ruptured plaque in the artery or a small blood clot, or anything that may be overlooked during an angiography.

By delving further into the problem, scientists may someday give us a concrete answer to the question “How can we mend a broken heart?”

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