Beware broken heart syndrome

Valentine’s Day looms on the near horizon. A day for chocolate, roses, and smarmy greeting cards. A time to express undying affection for those we love. But you already know where this is headed, don’t you? While people everywhere prepare to give voice to their heart’s longing, a PHC blogger is going to throw a bucket of cold water on the flames. I am not trying to be curmudgeonly, but I do want to remind all readers of this blog that not everyone can languish in love. Some are betrayed, forsaken, and broken hearted.

In fact, some people who suffer acute and significant emotional loss can literally experience “broken heart syndrome.” You may recall learning about this illness during your medical training. It may have been referred to by the more mundane monikers of stress cardiomyopathy or takotsubo’s cardiomyopathy, but I find the term broken heart syndrome more lyrical and engaging.

Broken heart syndrome, to refresh your memory, is more common in women than men (80% vs 20%). It is most frequently seen among those in their mid-50s to mid-70s. It is often initiated by an acutely stressful or traumatic event. A person with broken heart syndrome typically presents like someone with an acute MI: significant anterior chest pain, along with dyspnea, hypotension, and EKG abnormalities, usually ST segment elevation. Cardiac enzymes can be elevated, but the increase is milder than would be expected for the clinical presentation. Broken heart syndrome should be part of one’s differential in a post-menopausal woman who has just suffered a major emotional trauma, and who presents with what seems to be a significant MI, but whose enzyme elevation is only small. The coronary arteries are usually normal on angiography, but an echocardiogram will frequently show ballooning and hypokinesis of the left ventricle. The etiology is uncertain, but the condition may be due to an acute catecholamine surge.

Fortunately, the clinical malady of broken heart syndrome often evolves similarly to the emotional malady of a broken heart. Though the initial symptoms are quite severe for both conditions, they tend to resolve with time and basic supportive therapy. Broken heart syndrome may require treatment for CHF, but the problem typically resolves after a few weeks. An emotionally broken heart may actually take longer to heal, which points to the power of emotion in human health and well-being. But supportive care and tincture of time are the keys to recovery.

Oh, one other point, in the interests of full disclosure. Epidemiologists report no seasonal variation in broken heart syndrome. There is no particular peak in occurrence at Valentine’s Day. Hopefully no patients among readers of this blog will suffer a broken heart, emotionally or physically, on February 14, but let’s all keep our eyes and ears open, just in case.

Richard Fleming, MD

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