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Broken Heart Syndrome

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Abstract

Individuals can die from a broken heart. Although the concept of actually dying from a broken heart used to be thought of as an old wives' tale, there is now evidence that one's heart can suffer a severe and sometimes fatal physiologic consequence after a severe emotional stressor. The body's response to stress, both positive and negative stress, is the release of stress hormones or catecholamines that can have varied and extreme effects on the body. Stress cardiomyopathy, otherwise known in lay terms as broken heart syndrome, occurs when the cascading effects of catecholamines lead to changes in the cardiac system, particularly the coronary arterial system and/or the cardiac cells, which can lead to cardiac dysfunction. With prompt diagnosis, including an accurate history of a recent emotional stressor, this condition can be treated and is reversible in most cases. But in the small percentage of cases that may be fatal, those individuals do indeed die from a broken heart.

Introduction

She lost her only son from a massive cardiac arrest when he was only 47 years old. It was unexpected and sudden; and he was so young and always healthy. He died in New York. She lived in Miami where he was now to be buried. It took days to bury him as a hurricane was potentially going to strike in Miami. Flights were delayed in and out. Her anxiety deepened. Her tears continued to flow. Finally, it was time. Against her religious beliefs, she had the cemetery open the coffin to be sure it was her son, to say her final goodbye.

For the next 4 months, she never quite recovered. She cried in disbelief. She questioned why over and over again. She started to pull away from her husband, remaining adult children, and friends. She spent extra time with her adult granddaughter, her best friend. It was as if she knew … her heart was breaking.

She had just been to the doctor for a checkup. Everything was ok, she was told. But it was not, and she was not. And 4 months to almost the day her only son died, she collapsed and died too. No matter what the death certificate indicated as the cause of death, we knew, it was a broken heart that took her ….

Section snippets

Background/epidemiology/etiology

Stress or stress-induced cardiomyopathy (SICM) is also known as Takotsubo cardiomyopathy and broken heart syndrome. No matter the terminology, this transient left ventricular apical ballooning syndrome (Golabchi & Sarranfzadegan, 2011) occurs secondary to intense emotional or physical stressor(s). It is also often referred to as a similar event to acute heart failure (2011). Broken heart syndrome was first described by the Japanese in the early 1990s. The midventricle and apex of the heart,

Clinical presentation

The presenting clinical symptoms of SICM would be similar to those reported with a myocardial infarction. The most commonly reported symptoms are chest pain/angina pain and dyspnea. The patients may also complain of feeling their heart skip a beat, flutter, or other changes in cardiac rhythm. There may also be findings related to a decrease in perfusion as less blood flow is filling the arteries and left ventricle, thus changes in vital signs (tachycardia and hypotension), decreases in

Diagnosis

Diagnosis of SICM is made by examining both clinical presentation and with the use of diagnostic testing. To determine if SICM is present, it is important for the clinical provider to assess if an acute and severe emotional and/or physical stress has precipitated chest pain. Once this has been found to be present, then diagnostic testing can be used to confirm such a diagnosis.

The electrocardiogram may show evidence of cardiac dysrhythmias from tachycardia to, in some cases, ischemia. In some

Clinical management

Once a patient has been diagnosed with SICM and a myocardial infarction has been ruled out, clinical management may begin. Treatment for patients with SICM is usually supportive in nature. Beta blockers may be prescribed as they are known to block catecholamine excess, which may be the potential stimulus for the development of SICM. It should also be noted that catecholamines should not be administered for patients who have experienced SICM.

Although this condition is often temporary and

Nursing perspective

The nurse is the center of the health care team, advocating for the patient and often being the main provider of emotional support and care. The need for this type of care is no greater than in an individual with broken heart syndrome, with its identified link to emotional stressors. From the entry into the health care system, through the diagnostic procedures that ensue, to the eventual patient response as recovery or in a small number of cases, fatality, the need for the nurse to care for the

Prognosis

In most cases, individuals who develop SICM do not die from this condition; in fact, most women recover without further sequelae. If a complication does develop, it is usually left-sided heart failure, with or without the development of pulmonary edema. The aforementioned pharmacologic interventions are often used to prevent the development of such conditions.

According to researchers at Johns Hopkins University, patients with broken heart syndrome have been followed for as long as 5 years after

Happy heart syndrome—similar research findings

In the past year, there has been research conducted on patients who present with the same clinical etiology and presentation as broken heart syndrome, but the stressful precipitating factor is related to a positive stress event rather than a negative stress event.

Templin (2016) and her fellow researchers at the University Hospital in Zurich analyzed data from 1,750 patients in nine countries. They found that 4% of the events that led to symptoms of SICM were happy stress events, such as the

Conclusion

Until 1990, no one gave any credence to the physiologic condition we now refer to as broken heart syndrome. When researchers in Japan discovered stress SICM, the door opened to exploring the risks, prevalence, pathophysiology, management, and prognosis of this condition. On their journey to learning all that they could about a condition that mimicked a myocardial infarction, but was not, they also discovered the impact of a severe stress on the cardiac system, particularly in a healthy heart.

Lois S. Marshall, PhD, RN, Miami, FL.

References (23)

  • K.A. Bybee et al.

    Systematic review: Transient left ventricular apical ballooning: A syndrome that mimics ST-segment elevation myocardial infarction

    Annals of Internal Medicine

    (2004)
  • Cited by (0)

    Lois S. Marshall, PhD, RN, Miami, FL.

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