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"Broken Heart Syndrome" Caused By Emotional Stress

Recently, researchers at Johns Hopkins Medical University School of Medicine found that sudden emotional stress can trigger a severe heart muscle weakness that initially appears as symptoms of a heart attack. "Broken Heart Syndrome," medically known as stress cardiomyopathy, is a sudden cardiac event (which is reversible) that is often misdiagnosed as a heart attack.

In a study published in The New England Journal of Medicine, doctors report that this occurs when an individual’s reaction to severe emotional stress effects triggers a cascade of adrenaline and other stress hormones (catecholamine metabolites and stress related proteins) for several days that temporarily shock the heart. Typically these stress symptoms begin just minutes to hours after the person has been exposed to a severe, and usually unexpected, stress. Stress refers to the body’s response to things it perceives as abnormal. These abnormalities can be physical such as high body temperature, dehydration, or low blood sugar, or can be emotional, such as receiving news that a loved one has passed away. The victims of this emotional stress had experienced a variety of situations: being told of death, fear over a public speaking engagement, extreme anger, the shock of a surprise party, an auto accident, a robbery at gunpoint and stress anxiety over a court appearance.

Emotional Stress is the Trigger

As people feel overwhelmed by dramatic emotional stress health effects, their bodies discharge enormous quantities of stress hormones (and associated proteins created by a highly aroused nervous system) into the bloodstream. These biochemicals appear to have a temporary toxic effect on the heart (which shock the heart muscle) and trigger the standard symptoms of a real heart attack (chest pain, low blood pressure, shortness of breath, congestive heart failure and potentially life-threatening heart rhythm abnormalities).

Stress Cardiomyopathy - Different Processes Than a Real Heart Attack

No blockage or blood clots in the cardiac arterial system feeding blood to the heart.

No permanent (irreversible) damage to heart tissue.

No high levels of cardiac enzymes, indicating serious damage to heart muscle.

Faster recovery rates in the first few days and complete recovery in two weeks.

A distinctive contraction pattern, only found in stress cardiomyopathy, revealed through echocardiogram (ultrasound).

A distinguishing cardiac readout on the electrocardiogram (EKG).

“The researchers speculate that perhaps the stress hormones cause a spasm in the coronary arteries or, maybe, a potent toxic effect on the heart muscle. On the other hand, the adrenaline may bind to the heart cells directly causing large amounts of calcium to enter the cells, which renders them temporarily dysfunctional.

This is the first study to use biochemical analysis to prove a link between stress cardiomyopathy and elevated catecholamine levels. While doctors do not understand how the stress hormones are able to shock the heart muscle, they believe that stress cardiomyopathy occurs more often than many doctors realize, and that this research will help alert the medical community to correctly diagnose it when it occurs.

Future research will focus on finding out if certain individuals have a genetic susceptibility for experiencing stress cardiomyopathy and also to seek to identify the reason why this condition seems to mostly affect middle aged or older women.

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Sources: Takotsubo Cardiomyopathy Wikipedia (http://en.wikipedia.org)  Medline Plus  (www.nlm.nih.gov) Healthfinder Library (http://healthfinder.gov/library) Spectrum and Significance of Electrocardiographic Patterns, Troponin Levels, and Thrombolysis in Myocardial Infarction Frame Count in Patients With Stress (Tako-tsubo) Cardiomyopathy (Broken Heart Syndrome) and Comparison to Those in Patients With ST-Elevation Anterior Wall Myocardial Infarction American Journal of Cardiology Volume 101 Issue 12 Pages 1723-1728 (15 June 2008)

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