This week on Patient Talk I answered questions put to me by our Facebook followers at facebook.com/patient . I offered tips on how to deal with recurrent cystitis and when to worry about neck pain. But my heart went out to one of our followers, who had gone through huge life stress and ended up with a broken heart – which could, quite literally, have killed her.
Broken Heart Syndrome
People the world over talk about dying of a broken heart. When Debbie Reynolds died just one day after her daughter, Carrie Fisher, the automatic reaction might be that her heart couldn’t cope with the horror of losing her. In fact, Debbie Reynolds suffered a severe stroke – closely linked to high blood pressure, maybe the stress-related adrenaline pumping round her body pushed her blood pressure through the roof.
But there is actually a condition called broken heart syndrome. Its official title is Takotsubo Cardiomyopathy and it was first described in Japan in 1990, Cardiomyopathy is a medical problem (-patho, from pathology) with the muscle (myo-) of the heart (cardio-).
Takotsubo – what’s in a name?
Takotsubo means ‘Octopus pot’ in Japanese. The traditional octopus trap in Japan has a characteristic shape. In broken heart syndrome, the muscle in the wall of the heart becomes weakened. The left ventricle (the biggest of the four chambers of the heart, which makes up the tip of the heart) balloons out, taking on the appearance of a takotsubo.
Why does it happen?
As with so much in medicine, there are probably multiple reasons, and nobody is absolutely certain what’s going on. It may be related to the position of the coronary arteries, which supply the heart with blood. We do know that in about ¾ of cases, broken heart syndrome comes on after major stress, such as bereavement.
We also know that stress floods your body with adrenaline, the ‘fight or flight’ hormone. Thousands of years ago, adrenaline gave humans the edge, putting the body on high alert and making you better able to run away fast if you met a sabre-toothed tiger. But it comes at a cost. Conditions like anxiety disorders and panic attacks are closely linked to excess adrenaline. It’s thought adrenaline overdrive may be at least partly responsible for Takotsubo too.
What are the symptoms of Takotsubo?
The symptoms of broken heart syndrome are often mistaken for a heart attack. Your heart can’t keep pace with the demands of your body, and the result can be:
- Severe chest pain, often mistaken for a heart attack
- Shortness of breath due to fluid build-up in the lungs
- Abnormal heart rhythms (fast, slow or irregular heartbeats)
- Dizziness or collapse due to low blood pressure
- Occasionally, a stroke or cardiac arrest.
How is it diagnosed?
A diagnosis of Takotsubo is made when heart attack has been ruled out and the typical ‘octopus trap’ appearance of the heart shows up.
Treatment for Takotsubo depends on the symptoms it’s causing. For instance:
- If you have fluid on the lungs, you’ll get water tablets to help drain it
- If you heart is struggling, betablocker and ACE inhibitor tablets can reduce the strain it’s put under
- If your blood pressure is low, you’ll get tablets to stabilise it
- If you have a cardiac arrest, it’ll be red alert to get your heart going. After this, you may be considered for a device called an ICD (implantable cardioversion defibrillator). This is a tiny device placed under the skin of your chest. It tracks your heart rhythm and gives your heart an electric shock if you have another cardiac arrest.
What’s the outlook?
On the whole, the outlook for Takotsubo cardiomyopathy is good – at least from a physical point of view. About 95% of people make a full recovery within weeks with the right treatment.
But all too often, the original trauma that caused your heart to weaken can get forgotten in the drama of hospital admission. It’s hugely important to get the right support to help you get over a major life event like bereavement. The CRUSE helpline (link to website) is run by trained volunteers who have all dealt with bereavement themselves. They can offer invaluable counselling and support. Your GP can also provide help, including referring you for counselling. Please don’t hesitate – a healthy mind is every bit as important as a healthy body.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.