How extreme stress can literally break your heart
Grief, stressful situations and even physical shock can cause previously healthy people to develop life-threatening cardiac problems. Retired Co Kildare teacher Deirdre Doyle tells Kathy Donaghy about her experience of ‘broken heart syndrome’
Abroken heart is the subject matter for countless love songs, but experiencing a traumatic event like the loss of a loved one can have serious cardiac consequences. Broken heart syndrome, known in the medical world as stress cardiomyopathy or takotsubo, is a condition that was only recognised relatively recently, but may be more common than we think.
Because it’s often brought on by stressful situations, extreme emotions and even physical shock, it can strike healthy people who have never experienced cardiac-related problems in their lives.
It came as a massive shock to Deirdre Doyle (66), from Co Kildare, to learn that she had developed the condition and became seriously ill as a result.
The retired teacher, who prides herself on being fit and active with lots of interests and hobbies, is keen to make people aware of the condition she developed — one that most of us have never heard of.
In Deirdre’s case there was no shock news or one stressful situation that she can think of that led to her becoming gravely ill. However when she looks back, there was some physical exertion which may have triggered the onset of stress cardiomyopathy.
While Deirdre describes herself as an easy-going person, when she looks back to the period before she was taken away in the ambulance, she can see signs of stresses building up.
Her husband’s sister Antoinette Kavanagh passed away after an illness on May 28 — Deirdre’s birthday — and the family was badly hit by this loss.
“She had a great attitude to her illness and she kept really positive. We saw her regularly but when restrictions came in we didn’t get to see her and we kept in touch via WhatsApp,” explains Deirdre.
In terms of losing Antoinette, Deirdre believes that it was a great cause of sadness in their lives even before she died. “We were pretending that all she was going through was going to have a good outcome but deep down we knew it wasn’t going to be good. We spent a lot of time chatting and you are holding all that sadness in you.
“Looking back I know I was feeling under par. Physically I was fine but I wasn’t full of the joys. Maybe I was more tired than I realised.
In my case maybe the stresses were building up and the physical exertion contributed to it,” she says.
On June 18 last year, on what was a beautiful warm and sunny day, she decided to cut the grass before lunch. The mother of two grown-up children and grandmother of one remembers her husband cautioning her not to use the mower as it was heavy, but she reassured him that she’d be fine. She recalls going across the lawn a few times before becoming faint and having to sit down.
After making her way to a garden bench she rested but the feeling was unusual. The short journey back to the house made her feel shaky, like she was losing her balance. A lie down on the sofa and a cup of tea didn’t restore her, in fact she threw up immediately afterwards.
Deirdre’s instinct was that something wasn’t right. She took the advice of her sister, who works in a medical centre, to see a doctor. After being violently ill on the way to the doctor, Deirdre became very worried.
After initial tests, an ambulance was called and Deirdre was brought to Naas General Hospital. While she doesn’t remember much about the time, she spent that night in the ICU and on the advice of doctors was transferred to the Mater Private Hospital by ambulance the next day.
“I remember the angiogram and the doctor saying ‘this woman has no blocked arteries, they’re clear’. A nurse came and asked me if I’d ever heard of a broken heart. I said, ‘do you mean an emotional broken heart?’ That was the term she used,” says Deirdre.
She spent three days in ICU while her doctors worked to stabilise her heart rate. The treatment involved the insertion of a pump to keep her heart doing its job. It was only when she was able to leave the ICU and go to the cardiology ward that what had happened was fully explained.
While it wasn’t a heart attack, her heart had gone into a kind of shock. Despite the risk of Covid-19, Deirdre is glad she called for help. She says the reason she wants to talk about what happened to her is to remind people how important it is to get checked out if they experience symptoms that are unusual.
According to Professor Robert Byrne, director of cardiology at the Mater Private
‘I remember the angiogram and the doctor saying ‘this woman has no blocked arteries — they’re clear’. A nurse came and asked me if I’d ever heard of a broken heart. I said ‘do you mean an emotional broken heart?’
Hospital in Dublin, broken heart syndrome may be more common than previously thought.
Prof Byrne, who is also chair of cardiovascular research at the Royal College of Surgeons in Ireland, explains that the condition was first discovered in 1990.
“While we thought it was rare, it can occur in 1-2 pc of patients who are admitted to hospital with a suspected heart attack. We end up seeing it a few times a year,” he says.
With around 5,000 people every year admitted to hospital with a suspected attack, the numbers suffering from stress cardiomyopathy could be as high as 100 patients a year.
In many cases the condition can masquerade as a heart attack because the complaints of the patient are similar to the symptoms of a heart attack. And it’s only when a patient is brought to the cardiac catheterisation — cath lab — for an angiogram that it can be diagnosed.
This procedure involves a long thin tube called a catheter being inserted into the body through an artery or vein and threaded through the blood vessels to the heart, where doctors can see how many narrowings are present in the blood vessels.
Prof Byrne explains that it can only really be diagnosed when a patient gets to this stage. Symptoms, he says, are very similar to those of a heart attack and patients can feel chest discomfort, shortness of breath and profound fatigue.
“The features that distinguish it for us in the cath lab are that instead of finding blocked arteries, you find the arteries are open. There is a particular pattern you see in the heart muscle, part of it stops working and another part works harder to compensate,” he says.
For cardiologists who find the condition, Prof Byrne says the important thing is to determine what brought it on. In around one third of cases, stress or an emotional trigger, causes the onset of the condition, in another onethird it is a physical stress or illness, and in the remainder the trigger is unknown.
In cases where the trigger is shocking news, Prof Byrne says it’s believed that a huge surge of stress hormones delivered to the body damages the heart muscle.
In many cases people who are otherwise quite well can be struck down, which is why it’s really important that people feeling symptoms like chest pain, extreme fatigue or shortness of breath should always seek medical attention, he says.
Covid-19 may also have a role to play in some cases, according to Prof Byrne. “There are certainly a number of reports of stress cardiomyopathy brought on by stress associated with both Covid-19 illness itself and the pandemic in general. In Deirdre’s case we were concerned about this and tested her twice for coronavirus, with both tests reported as negative. In fact, a recent study from the United States suggested that of patients admitted with heart attack, 7.8 pc of cases were diagnosed with stress cardiomyopathy.
“This represents about a four to five-fold increase compared with what is generally expected and may reflect generally higher levels of stress in the community due to the coronavirus pandemic.
“For some reason 90 pc of people affected by this condition are women and it seems to affect mostly people between the ages of 60 and 75. The vast majority of people who get bad news don’t end up with something like this but it’s good for people to know about it. Cardiologists are familiar with it but GPs may be less familiar with it. Although patients can get very sick with it, it’s generally a good diagnosis to have because the vast majority of people get better after one to four weeks.
Treatment consists of supportive therapy and medication in the acute phase followed by rehabilitation therapy. For most people rehab will be the resumption of exercise in a controlled environment to start with and getting advice about what you can and can’t do and staying within your limits.
Now back to her full health, Deirdre says she was determined to build up her confidence which took a knock after her experience. She has worked with a cardiology rehab programme run by Naas General Hospital.
She explains that the fact she was monitored during an exercise-based programme allowed her to get her confidence back.
“I have complete confidence again.
I’m back walking and at the end of last summer I got to the sea. I knew I had to take it easy and build myself back up to where I was. I enjoy life to the full again,” says Deirdre.
“What happened was very traumatic at the time, especially when I felt so healthy. But I have made a complete recovery. I wouldn’t say this has slowed me down. I’d just turned 66 when it happened so I do listen to my body more”.
Deirdre says she doesn’t take on what she calls heavy work anymore. “While people might not have heard of this, it is a heart issue, just a different kind of heart issue and I’m very aware of that,” she adds.
‘There are certainly a number of reports of stress cardiomyopathy brought on by stress associated with both Covid-19 illness itself and the pandemic in general’