Mahmoud Sharaf, MD
Eau Claire Heart Institute
“Doctoring her seemed to her as absurd as putting together the pieces of a broken vase. Her heart was broken. Why would they try to cure her with pills and powders?”
— Leo Tolstoy, Anna Karenina
Broken Heart Syndrome was first described in Japan in 1990 by Dr. Hikaru Sato and his colleagues. In fact, up to 2% of all cases initially described as heart attacks proved in actuality to be Broken Heart Syndrome. Asians and Caucasians seem to be is proportionately affected compared to other ethnic groups. It occurs much more commonly in women than men, and is more common in the age group of 60–80 years. That being said, some cases have been documented even in children and adolescents.
Broken Heart Syndrome may present very much like a heart attack: chest pain, shortness of breath, sweating, palpitations and lightheadedness. In two-thirds of cases, there is a history of a stressful life event in the two to four weeks prior to hospital presentation. Stressors can include learning of the death of a loved one, bad financial news, legal problems, natural disasters, motor vehicle collisions, exacerbation of a chronic medical illness, a newly-diagnosed medical condition, surgery, an intensive care unit stay and the use of or withdrawal from illicit drugs.
As with a conventional heart attack, the EKG (heart tracing) will show worrisome changes and blood tests, such as troponin, will be elevated. As a result, patients with Broken Heart Syndrome often will have invasive heart tests, such as angiograms performed. However, the mechanism of Broken Heart Syndrome is different than for a conventional heart attack. With broken heart syndrome, the emotional stress causes a surge of circulating hormones leading to spasm of multiple coronary blood vessels. As a result, the heart muscle bulges out, and is ineffective in contraction. With a conventional heart attack, there is a distinct blockage within a coronary blood vessel.
Broken Heart Syndrome therefore is not generally treated with balloons and stents. Medications such as aspirin, beta-blockers, ACE inhibitors do have a role in Broken Heart Syndrome. In fact, beta-blockers such as metoprolol taken long term may decrease the risk of recurrence.
Twenty percent of cases of Broken Heart Syndrome are associated with immediate in hospital complications. These may include heart failure, blood clot formation, low blood pressure and abnormal heart rhythm. However, once the immediate danger has passed, the prognosis is very good with 95% of patients making a full recovery in about eight weeks. The overall mortality rate with Broken Heart Syndrome is on the order of 1–3%, less than for conventional heart attack.
In conclusion, the answer to the title question is YES. The good news is that in this age of modern cardiology treatments, the mortality rates from a broken heart are very low with appropriate diagnosis and treatment.
Dr. Buenger – OakLeaf Advanced Wound Care& Hyperbaric Medicine Center
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