A recent article in the Journal of the American College of Cardiology described stress (tako-tsubo) cardiomyopathy as "a rapidly reversible form of acute heart failure reported to be triggered by stressful events and associated with a distinctive left ventricular (LV) contraction pattern." Oooh, romantic. Shakespeare couldn't have written it better.
The mysterious malady mimics heart attacks, according to an article from the Wall Street Journal, but appears to have little connection with coronary artery disease.
Instead, it is typically triggered by acute emotion or physical trauma that releases a surge of adrenaline that overwhelms the heart. The effect is to freeze much of the left ventricle, the heart's main pumping chamber, disrupting its ability to contract and effectively pump blood. The phenomenon is a 'concussion' of the heart, says Scott Sharkey, a cardiologist at Minneapolis Heart Institute. 'It's really a heart attack which is triggered by stress rather than by a blocked artery,' he says.The tako-tsubo name comes from Japanese researchers who first identified the condition and noticed the left ventricle looked like a vase-like pot used in Japan to trap octopuses called tako-tsubo.
While there have been a number of presentations of stress cardiomyopathy (SC), "there is a paucity of data from large and prospectively identified patient cohorts studied for extended periods of time following the initial event," the authors wrote, so they wanted to "define more completely the clinical spectrum and consequences of SC beyond the acute event."
Over a period of about seven years, 136 patients presented with SC to the emergency and hospital facilities of the Minneapolis Heart Institute and Abbott Northwestern Hospital (in the great city of Minneapolis, Minnesota). They had similar features as a heart attack, but without the clogged arteries. The patients were between 32 and 92 years old and the overwhelming majority (96%) were women. The most common presenting cardiovascular symptoms were substantial chest pain (63%), exertional dyspnea (shortness of breath; 18%), and syncope (loss of consciousness/fainting; 3%).
Most of the patients (89%) had experienced severe stress in the previous 12 hours; triggers were roughly split between emotional (47%) or physical (42%). The emotional triggers were seen more in women while the physical triggers were seen more in men.
You'll note I just said most of the patients - this means that in a small number of patients (11%, 14 women), "a stress trigger could not be elicited, despite repeated questioning."
This in itself is an interesting finding, as the "typical SC patient has been characterized as an older woman experiencing an intensely stressful event that acts as a trigger for acute, but reversible, heart failure with systolic dysfunction." Yet the authors' data suggest that:
The clinical profile of SC is considerably broader, with an important minority of patients relatively young (50 years of age; range to 32 years) or men. Also, unexpectedly 11% of patients related no emotional or physically stressful event immediately before hospitalization, despite demonstrating typical angiographic and ECG features of this condition. This latter observation has implications for both the nomenclature and pathophysiology of this condition. Indeed, the descriptive term used here and commonly in the literature, stress cardiomyopathy, does not reliably describe all affected patients with this syndrome, each of whom do in fact demonstrate transient ventricular ballooning.So what becomes of the broken hearted? Excellent question, Jimmy Ruffin. You can't unbreak your heart, Toni Braxton, but you can recover fully. Although the overall number of patients who suffer from SC is small, the treatment for these patients is really different than that prescribed for patients with a conventional heart attack, the WSJ says. For one thing, it's risky to give a clot-buster drug to a patient without an arterial blockage, due to the potential to cause a
Although you can recover fully, doctors really aren't sure what the long-term consequences are after an episode of SC. "Notably, our follow-up analysis showed that the survival of SC patients was reduced compared to that expected for an age- and sex-matched general population; in each case, mortality was due to non-cardiac diseases (predominantly cancer), most frequently in the first year following the initial SC event. These data suggest that SC itself may represent a marker for generally impaired health and well-being, albeit in contrast to an earlier report. On the other hand, fully one-third of our patients who survived their initial event have achieved normal life expectancy (i.e., age ~ 75 years)."
Once more research comes out, the News Staff can update the juggernaut that is Chemistry of Love.
Sharkey et al. Clinical Profile of Stress Cardiomyopathy. JACC Vol. 55, No. 4, 2010 January 26, 2010:333–41.
Other Scientific Blogging articles on this topic:
Depression and cardiac events
Science of the broken heart