A BROKEN HEART CAN BE MENDED

When is a heart attack NOT a heart attack?

Severe crushing chest pain hits you. ... OMG–a heart attack! Or is it?

You still must take that dash to the nearest emergency department. However, there is a chance that you could be suffering takotsubo or broken heart syndrome, especially if you are a middle-aged woman – still serious but not a heart attack.

This particular onset of pain shows the classic markers of a heart attack, in that it:

• presents as if the patient’s arteries are blocked

• looks like a heart attack on the electrocardiogram (ECG) and

• a blood test shows raised troponin levels.

While it is not a heart attack, as the arteries are not blocked, the heart is still in severe stress.

What has happened?

Generally, takotsubo cardiomyopathy occurs after a huge outpouring of emotional stress or nervous activity in the body. Common triggers include:

• death of a loved one

• a serious accident

• a fierce argument

• unexpected loss

• sudden illness.

While the precise cause is not known, experts believe that surging stress hormones such as adrenaline can ‘stun’ the heart, triggering changes in heart

muscle cells and coronary blood vessels that prevent the left ventricle (LV) from contracting efficiently. The LV is one of four chambers in the heart and is the main pumping chamber. Such sudden weakening of the LV affects the heart’s pumping ability.

Diagnosis.

For a person having presented at the emergency department, a CT coronary angiogram or an invasive coronary angiogram is used to establish the health of the patient’s arteries. If there is a narrowing or a blockage, it is very hard to make the diagnosis of takotsubo.

A takotsubo heart is characterised by its shape. Instead of being bullet shaped, the heart becomes a collar with a bulb. The heart’s appearance looks like, and takes its name from, a Japanese octopus pot which has a ring at the top and a bulbous bottom. This shape is the condition’s diagnostic characteristic.

Middle-aged women.

Most commonly, broken-heart syndrome affects middle aged women, particularly after menopause. More than 90% of reported cases are in women aged between 58-75 years old. Although the syndrome can affect men, the occurrence is far less frequent.

Approximately 5-10% of people presenting with what appears to be a heart attack have a takotsubo heart. While the condition is not that rare, it is uncommon for the condition to kill the person, although recovery can take several months. Failure to recover would prompt looking for another diagnosis.

About 10% of patients have a second episode.

Treatment.

Broken heart syndrome is treated as if the patient were suffering cardiac failure (CF). CF occurs when the pumping capacity of the heart does not match the cardiac output required by the body; essentially, when the heart fails to pump as it should which leads to a cascade of consequences throughout the body.

The use of a family of drugs called betablockers helps dampen the over-drive effect of the sympathetic nervous system which is the ‘fight or flight’ part of the body’s autonomic nervous system– remembering that an outpouring of the nervous system probably caused the problem initially.

The best advice is for middle-aged women not to become too emotional!

Summary.

Tabotsubo, or broken-heart, syndrome:

• presents as a heart attack, but isn’t

• occurs most often in middle-aged, post-menopausal women

• rarely causes death

• can be treated, but recovery may take several months.

Dr Warrick Bishop is a cardiologist with special interest in cardiovascular disease prevention incorporating imaging, lipids and lifestyle. He is author of the books ‘Have You Planned Your Heart Attack?’, ‘Atrial Fibrillation Explained’ and a new book ‘Cardiac Failure Explained’. The books are written for patients and doctors about how to live intentionally to reduce cardiovascular risk and save lives! Dr Bishop can be contacted via his website.