Hearts Actually Can Break

DesScorp writes "It seems that there's a grain of truth to one old wives' tale; it turns out that you really can die of a broken heart, especially if you're a post-menopausal woman. The Wall Street Journal reports on a phenomena called 'broken-heart syndrome,' which often occurs after great emotional distress. Quoting: 'In a conventional heart attack, an obstructed artery starves the heart muscle of oxygenated blood, quickly resulting in the death of tissue and potentially permanently compromising heart function. In contrast, the heart muscle in broken-heart-syndrome patients is stunned in the adrenaline surge and appears to go into hibernation. Little tissue is lost.' In the article a doctor notes, 'The cells are alive, but mechanically or electrically disabled.' Documented cases track heart attacks in people with seemingly healthy hearts after the grief of the death of a loved one. Intense feelings can cause the heart actually to change shape. Doctors call this 'tako-tsubo,' after the Japanese phrase for 'octopus trap,' so called because the syndrome was first identified by a Japanese doctor who noticed the strange shape in the left ventricle. Doctors note that while strong emotions like grief are usually associated with the syndrome, stress or a migraine can also trigger such heart attacks."

Comments

In 2005, according to Dr. Ilan Wittstein

[ls671]

Hmm... According to this 2005 article, Dr. Ilan Wittstein came to the same conclusion after conducting a study:

http://findarticles.com/p/articles/mi_m1355/is_11_107/ai_n13452973/

Some might have conducted similar studies prior to his.

I think everybody knew this.

[santax]

I am 31, had my heart broken 2 times. Really really broken. When my mom died and when I lost a girl I thought would become ms. Santax. I think everyone already knew this. It really hurts and it hurts where your heart is. Big time.

Re:I think everybody knew this.

[Cornelius the Great]

You may want to read up on Greater Internet Fuckwad Theory. Generally, a having both an audience and anonymity brings out the worst in people.

Don't try to reason or argue with trolls, especially AC ones. They thrive on the attention.

Re:Hmm...

[Dunbal]

I am a doctor.

The problem is recognizing that there actually is a problem. So many patients come in complaining of chest pain. However medicine is never about what the patient "says" is the problem (subjective data) but rather what we can objectively observe to be the problem. That's because medicine is about science, not speculation. The clinical history orients us to a range of possibilities (chest pain can be anything from muscular to pulmonary to digestive to cardiac/great vessel to neurological problems). We then ask further questions and perform tests to exclude/include certain conditions.

Because chest pain is so vague and also so common, we rely on EKGs and cardiac enzyme tests to confirm a diagnosis. Now there's a whole argument that the consequences of a heart attack are so severe that if there is doubt, we will treat it as a heart attack solely on strong clinical findings even when tests are inconclusive. However what usually happens is that the clinical history (heart disease in the family, patient age, blood pressure, cholesterol, diabetes, obesity, smoking, previous heart attacks) doesn't point to a heart attack, nor is the type of pain consistent with angina, and therefore the pain is "written off" as Treitze syndrome, either correctly or incorrectly. The patient is sent home. And usually NOTHING HAPPENS. It's very rare that patients are sent home to die of a heart attack.

However a study like this (provided it receives more supporting studies) opens up a few more possible diagnoses. However I would argue that the actual "mortality" (how many people die) or "morbidity" (how many people are permanently damaged) of this "broken heart" syndrome is very very low. So now do we treat anyone with chest pain as a heart attack "for the benefit of the doubt"? How much will this cost both the patient and the tax-payer in public health systems? Hell, if we're going to treat everyone, we don't even need doctors anymore, right?

No - medicine is still about evaluating a patient and the risks and benefits of treating versus telling them "take 2 tylenol and call back in the morning". As far as I am concerned this type of information changes nothing as there is no significant evidence that people actually die this way. While this so called "broken heart" syndrome can degenerate into dysrhythmias and/or plaque rupture and heart attacks, well, we already know about those.

Re:liquid nitrogen

[Anne_Nonymous]

Or perhaps not.

Reversed Knowledge

[DynaSoar]

"...while strong emotions like grief are usually associated with the syndrome, stress or a migraine can also trigger such heart attacks."

Could someone please educate the author, and if necessary the researchers (though I doubt it necessary) that strong emotions like grief are stressors, as are physiological disorders like migraines? Stress is the set, grief a subset. TFA seems to imply otherwise.

Any pressures to the system are stressors, and the system requires stress in order to function. Problems are due to poor handling of stress, which is called dis-stress. Turning stress to motivation is called eustress. Too much of the former (or too poor a job at handling it) can cause damage.

Re:All the more reason...

[TheCarp]

> It's called Ecstasy.
>
> Makes you happy and warm and fuzzy, then you crash and are left depressed and stupid (which doesn't totally wear off).

Actually, thats not always the case. I, and several others, have experienced "ecstasy afterglow" where the next 2-3 days after the experience were actually quite pleasant. In fact, I was in a much happier mood than normal, and less depressed for that period.

Now, when you say ecstasy do you mean MDMA or do you mean "pills called ecstasy". I have had it offered to me, and taken it, about 4 times (and not in several years at this point). Twice it was almost certainly MDMA, based on effect and duration, once it was almost certainly MDA, and once just speed. The time that I was most sure that it was real MDMA is the only time that I got the afterglow effect, but its been reported to me by a few other people.

-Steve

Re:Hmm...

[MMC Monster]

With such presenting signs, there is NO WAY such a patient is going to be "sent home" anyway. So frankly the original article is just a bunch of sensationalist writing trying to imply something new about things that we already know. OK, it's nice to have a name for it. Yes, there's probably a constellation of signs that differentiate it from the "non-Takotsubo" AMI which you as a specialist know all about. The prognosis is probably different, from what you imply. However my point is we've known that stress is one of many risk factors for AMI for years. What's new?

What's different is that this isn't an AMI at all. Myocardial infarction quite literally means death of the myocytes (heart muscle). In this cardiomyopathy, there is little if any dead muscle. There's a lot of stunned muscle. The difference is that if the muscle dies, there's nothing that can be done to make it move again. If it is stunned, it will move again on it's own, given enough time to recover.

The other thing is that the stress that causes Takotsubo cardiomyopathy causes a very different effect on the heart than the stress that causes an acute myocardial infarction. In AMI, the stress causes plaque rupture in one of the coronary arteries, leading to thrombus formation within the coronary artery and obstruction to the flow of blood. In Takotsubo, it's unclear what the stress actually did, but it certainly isn't causing a demonstrable plaque rupture. It's possible that it's causing transient spasm of the left main coronary artery, or possibly spasm of the entire capillary bed.

Also, Takotsubo cardiomyopathy has been known about for more than a decade. It just gets in the news every Valentine's day or so. :-)