Our society attributes emotional attachment to the heart. Phrases such as "kind-hearted" or "cold-hearted" or "heartbreak" suggest that we think of the heart as the source, or the victim, of experiences that trigger intense emotional responses. Many of us have heard of people who lost their life mate, and died soon after, "of a broken heart". From a scientific perspective, this had not been proven if it was even possible until very recently.
In 1990, in Japan, doctors described a heart condition where the tip of the heart ballooned out and resembled an octopus trap, resulting in symptoms that appeared to mimic a true heart attack, sometimes even with electrocardiogram findings that looked like a heart attack. However, when they studied the arteries supplying the heart, they were normal. the Japanese doctors called this condition Takotsubo cardiomyopathy (cardio = heart, myo = muscle, pathy = disease), and this condition quickly gained the nickname "Broken-Heart Syndrome". The first reports of this condition appeared in the medical literature in the US in 1998.
Triggers for this condition include intense emotional duress - loss of a loved one, learning of a terminal illness, financial ruin, intense disappointment, serious illness, severe pain, physical violence, or even crippling fear, such as that associated with public speaking or facing a dreaded task. Symptoms typically develop a few minutes to a few hours after the triggering event.
Symptoms of Takotsubo cardiomyopathy include the usual symptoms we associate with a classic heart attack - shortness of breath and chest pain. 90% of these cases occur in females between the ages of 50-75. ECG may look like that of a person having coronary blockage. Echocardiogram may show wall motion abnormalities - certain sides of the heart muscle may not squeeze with the vigor of the other walls of the heart, and this is visible on echocardiogram. Coronary angiogram typically reveals clean coronaries, and unless doctors are aware of this diagnosis, they may think it is a false positive, or another condition called MINNC (MI with near normal coronaries). As the heart muscle bulges out and weakens, symptoms of heart failure can develop - swelling, shortness of breath, fatigue, weakness.
Treatment for Takotsubo is similar to the treatment for garden-variety heart failure that we see every day- beta blockers to suppress the adrenergic tone, ACE inhibitors to prevent remodeling of the ventricle, and diuretic therapy to control the fluid buildup. Fortunately, the abnormalities associated with this condition usually resolve within a month and the symptoms resolve, allowing the patient to lead a full life. In some cases, permanent heart failure can occur, and rarely, death may occur.
Currently, research is being conducted to attempt to identify the exact stress hormones that are released, how the body responds, and why the heart is temporarily stunned by these stress hormones. As we learn more about the human body, it becomes evident how important emotions are to our well being, and how destructive they can be when a person is overwhelmed by stress.
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