It looks, feels and acts like a heart attack, but it's a broken heart
DULUTH, Minn. -- It was the Bee Gees who posed the question: "How can you mend a broken heart?" Dr. Kathleen Braddy has the answer. It turns out there is such a thing, medically, as a broken heart, although it might not be the sort of thing about...
DULUTH, Minn. -- It was the Bee Gees who posed the question: "How can you mend a broken heart?"
Dr. Kathleen Braddy has the answer.
It turns out there is such a thing, medically, as a broken heart, although it might not be the sort of thing about which the Bee Gees were singing.
"The big muscle of the heart fails to work," Braddy said, describing the condition. "Heart arteries are still open, blood flow is working just fine, but the heart muscle basically just fails."
How can you mend it?
"It's really medicines, medicines like (for) congestive heart failure," said Braddy, a cardiologist at the Essentia Health Heart & Vascular Center in Duluth.
The medical condition wasn't identified until the early 1990s by Japanese researchers who named it takotsubo cardiomyopathy. Takotsubo is the Japanese word for an octopus trap, and that's what the left ventricle of your heart resembles if you have the condition, according to a report in the Texas Heart Institute Journal.
It's also known as stress cardiomyopathy, apical ballooning and broken heart syndrome, Braddy said -- and they all mean the same thing.
"You didn't have a heart attack," she said. "You don't have blockages in your heart arteries. What you have is a decrease in heart muscle function that we think is related to your body's response to high levels of emotion, high levels of stress hormone. ... Your body reacted to it by constricting blood flow even though there's no blockages causing damage to your heart muscle."
Your heart isn't working right. It's broken. The symptoms will be the same as if a person suffered a heart attack, Braddy said: Chest pains. Shortness of breath.
Health professionals will assume it's a heart attack and respond to a heart attack until proven otherwise. But in 1 to 2 percent of the cases, there's no blockage of the arteries. The heart muscle itself isn't working well.
It's highly unlikely that the 18-year-old who was jilted by his girlfriend has a broken heart, medically speaking, Braddy said. It's unlikely in his case for two reasons: Most of the patients are older, and most of them are female.
But the condition is tied to an emotional event about 25 percent to 30 percent of the time in some studies and as often as 50 percent in others, Braddy said. (The numbers in the studies are small, she cautioned.) Among the possible triggers are the death of a spouse or the death of an adult child.
There also can be physical triggers, she said, such as an accident, surgery or trauma.
"Anything that can gear us up, whether it's emotional or physical, can be associated with a trigger for it," Braddy said. "I think it's frequently not diagnosed."
She described a recent case in her practice, when a woman whose husband had died suddenly came into the hospital 48 hours after his death complaining of chest pains and shortness of breath. Results of an ECG were consistent with a heart attack, Braddy said.
The woman was rushed to the cath lab, where a coronary angiography showed no blockage in the arteries. But a "left ventriculography" -- a contrast picture -- showed the left ventricle, or pumping muscle of the heart, was decreased to 20 percent compared to a normal rate of 55 to 65 percent. It showed the apex, or tip of the heart, was not moving, while the base of the left ventricle was moving normally. The apex "appears ballooned out as it is not pumping normally," she said.
The chest pains and shortness of breath are the outward signs of that impaired heart activity.
The causes of the stress that can lead to broken heart syndrome are easy enough to see, said Gina Dixon, program manager for Essentia Health Grief Support Services.
"That stress is the identified factor -- that sense of either terror or powerlessness that people are experiencing after the death of a loved one," Dixon said.
Both Dixon and Braddy said broken heart syndrome may be the explanation, at least some of the time, when a long-married couple die within weeks, days or hours of each other.
Braddy's grandfather died soon after her grandmother, she said. His purpose had been to care for his wife, who had Alzheimer's, even after he suffered a stroke. When she died, he lost that purpose.
But there's no way to know if he actually died of broken heart syndrome, Braddy said. "There's no reason why we would have studied an 86-year-old man. We're not going to look for it."
But it can cause death -- in up to 20 percent of the more serious cases, Braddy said. It's also treatable, mostly through the aforementioned medications. Some patients recover completely, although Braddy said she'll usually recommend continuing one medicine at a low dosage.
Knowing that bereavement comes with physical risks, Dixon said she will also check with the grieving person to see when he or she has last seen a doctor.
"We really emphasize the importance of having a current physical, of being aware of the impact that stress has, not just on our moods but on our bodies," Dixon said. "Grief can be a real physical thing."
Likewise, Braddy encourages people who lose a loved one to seek grief support. "It's not something you should try to go through by yourself."