Stress-induced cardiomyopathy occurs when extreme emotional or physical stress triggers symptoms that mimic a heart attack, such as chest pain and shortness of breath. This condition is also referred to as takotsubo cardiomyopathy or "broken heart syndrome" and if not treated can be life threatening.
Broken Heart Syndrome Is a Real Condition
While it has been established that broken heart syndrome (stress-induced cardiomyopathy) does happen, the exact cause remains uncertain. Experts believe that after a stressful event, there is a surge of stress hormones, such as adrenaline, that are released. When this happens, it can cause a disruption in the pumping of the heart which can temporarily weaken and damage the heart muscle. The coronary arteries of the heart may also be affected. They can narrow or spasm during a stressful event which can cause circulatory problems and chest pain.
You Could Be at Risk
There is still research being conducted to determine why certain people are more susceptible to stress-induced cardiomyopathy. A few factors that may increase your risk include:
- If you are a woman
- If you are over 50 years old
- If you have a history of neurological disorders such as seizures or a head injury
- If you have psychiatric disorders such as depression or anxiety
- Your personality type
- Genetics
- Physical stress
- Emotional stress
Possible Triggers
Stress-induced cardiomyopathy can happen with 'good' as well as bad stressful events. Some examples of these types of events are:
- Death of a loved one
- Serious illness diagnosis
- Surgery
- Car accident
- Loss of a job
- A surprise party
- Fear
- Intense arguments
- Money problems
- Divorce
- Winning money
- Fall/injury
- Infection
Symptoms
Takotsubo cardiomyopathy symptoms can happen suddenly or up to a few hours after the incident. The symptoms are quite similar to a heart attack and can include:
- Chest pain
- Shortness of breath
- Low blood pressure
- Irregular heartbeat (arrhythmia)
- Dizziness
- Sweating
- Palpitations (pounding, fast heartbeat)
If you arrive at the hospital with heart attack symptoms, you will initially be treated for a heart attack. Once a heart attack is ruled out, the doctor will further evaluate you to determine if you have stress-induced cardiomyopathy.
How Stress-Induced Cardiomyopathy Is Diagnosed
Since the symptoms of a heart attack and takotsubo cardiomyopathy are so similar, your doctor will need to run some tests to make a conclusive diagnosis. The following tests may be ordered:
Electrocardiogram (ECG)
Wires are attached to your chest and your heart's electrical activity is recorded. It can detect irregularities in the heart rhythm and structure. The results of this test will determine if it's a heart attack or stress-induced cardiomyopathy.
Echocardiogram
This is an ultrasound of your heart. It will detect if the heart is enlarged or has an abnormal shape which can be signs of takotsubo cardiomyopathy.
Chest X-Ray
This test will also show if the heart is enlarged or has an abnormal shape which can be indicative of stress-induced cardiomyopathy.
Cardiac MRI
This test will provide very detailed images of the structure and function of your heart.
Blood Tests
If you're experiencing stress-induced cardiomyopathy, your blood tests will show an increased amount of certain enzymes in your blood. Blood tests can also help confirm if there has been any damage to the heart.
Coronary Angiogram
This test checks the coronary arteries for blockages. Dye is injected into the blood vessels of the heart and a series of X-rays are taken that show the blood vessels in great detail. When no blockages are found, the doctor may suspect stress-induced cardiomyopathy. If a blockage is seen on an angiogram, it indicates that the person has likely had a heart attack.
Treatment
While there's no standard treatment for stress-induced cardiomyopathy, it is treatable. There is usually no permanent damage to the heart and a complete recovery can be expected in a matter of a month or so. Some medications will be needed during the recovery process, which may include:
- Blood pressure medicine
- Blood thinners to prevent blood clots
- Diuretics to help remove fluid
These medications may need to be continued for three to six months or longer during recovery; the specific duration of time you need to be on these medications will be determined by your doctor.
Long-Term Effects
Typically, stress-induced cardiomyopathy is not associated with having lasting, long-term effects, therefore no long-term treatment plan is prescribed for the patient. However, recent studies found in Circulation the European Heart Journal have argued that there very well could be long-term effects on a patient's heart health. Based on the findings of these studies, it is suggested that after a patient recovers, he or she should continue to be treated in a similar fashion as those who are at risk for heart failure.
What to Expect After Recovery
It is always best to consult with your doctor, especially if you have any questions or concerns. He will recommend maintaining a healthy diet and exercise routine and make suggestions on how to recognize and manage the stress in your life. Most can rest reassured that the chances are low that this will happen to again and the long-term prognosis is excellent.
