Can hearts really break?

This is the 4741th article of Da Yi Xiao Hu

The phone in the emergency room suddenly rang in the early morning. An elderly female patient with recurrent ventricular tachycardia was about to be delivered. Medical staff quickly prepared ECG monitoring, rescue vehicles, defibrillators and other equipment. After the patient arrived at the emergency room, she was immediately given cardioversion and antiarrhythmic treatment and admitted to the ICU. After full treatment by the emergency department, ICU and cardiologists, the patient's vital signs gradually stabilized on the second day. After examination, no blockage was found in the patient's coronary artery, and myocardial infarction could be ruled out. After understanding the patient's medical history, the patient's lover passed away two days ago. The patient was in grief and had symptoms such as arrhythmia. After comprehensive consideration, the expert diagnosed the patient's disease as "broken heart syndrome." It seems that heartbreak is not just a literary description, but a real disease. Another name for it is Takotsubo syndrome (TTS). Takotsubo is a Japanese pot with a round bottom and a narrow neck used to catch octopuses.

Broken heart syndrome is a stress-induced cardiomyopathy caused when a person is under great pressure or emotional stimulation. Mild cases may cause premature beats and increased blood pressure. Severe cases may cause malignant arrhythmias such as ventricular tachycardia, ventricular fibrillation, and frequent premature beats, and even lead to sudden death. The disease may be accompanied by chest pain, and it feels as if the heart is really broken. However, it does not have organic changes such as coronary artery obstruction, but is caused by psychological or physiological stress. In the acute phase, due to the damage to the patient's left ventricle, abnormal apical contraction occurs, leading to balloon-like dilatation of the left ventricle. In imaging examinations, the patient's ventricular bottom swells into a spherical shape with a narrow neck, resembling a fish basket for catching octopuses, so it is also called "octopus pot cardiomyopathy."

In 1990, Japanese scholar Sato et al. first reported five cases of this syndrome. In 2005, Hunter Champion et al. of Johns Hopkins University in the United States called some symptoms similar to heart disease, such as chest pain, breathlessness and shortness of breath, caused by grief or shock, "broken heart syndrome" in the New England Journal of Medicine. The author admitted 19 patients who had chest pain, shortness of breath and other symptoms similar to heart attacks, but unlike heart disease patients, they recovered after bed rest and a small amount of treatment. These patients are basically all postmenopausal elderly women. The causes of illness include great grief caused by the death of relatives such as husbands, parents or children, or severe shock caused by car accidents, robberies, etc., as well as intense stimulation caused by intense arguments, court appearances and public speeches. Medical examinations found that they did not suffer from heart disease.

Broken heart syndrome is mainly caused by excessive emotion or sadness, but physical stress (such as heavy physical labor, strenuous exercise) can also cause it. The most common symptom is chest pain, which occurs in 75.9% of patients. The second is dyspnea, which may occur in 46.9% of patients. In severe cases, heart failure, cardiogenic shock, and even cardiac arrest may occur first. Other symptoms may include abdominal pain, vomiting, syncope, hypotension, abnormal mental state, cold limbs, oliguria, syncope, cardiogenic shock, malignant arrhythmia, and pulmonary edema.

At present, the cause of broken heart syndrome is still unclear. The main possible pathogenesis is the increase in the concentration of catecholamines in the blood. Catecholamines can cause myocardial microcirculation disorders, myocardial stunning, increased afterload, and cause changes in the patient's heart structure and function. Other hypotheses include abnormal myocardial metabolism and multi-branch coronary artery spasm, which need further research and verification.

Broken heart syndrome is common in postmenopausal women. The risk of women over 55 years old is 5 times higher than that of women under 55 years old, and women are 10 times higher than men. As people learn more about the disease, the number of male patients diagnosed is increasing, and children have also been reported, with the youngest patient being a premature newborn born at 28 weeks of gestation.

It is not easy to diagnose broken heart syndrome. Its clinical manifestations are very similar to those of acute myocardial infarction. If it is confirmed, invasive methods such as cardiac angiography are required. Treatment is mainly to relieve emotions or stress; if there are complications such as acute heart failure and shock, active treatment is required.

Broken heart syndrome is generally considered a benign disease, and most patients can recover from cardiac structural and functional abnormalities within a few months; however, recent observational studies have shown that the incidence of cardiogenic shock and death is comparable to that of patients with myocardial ischemia, and about 20% of patients may experience serious adverse events such as arrhythmias, cardiogenic shock, and pulmonary edema. Severe ventricular arrhythmias are the main cause of death, and they mainly occur 2-4 days after admission.

Broken heart syndrome is associated with strong emotional stimulation, and preventing "heartbreak" is the key to prevention. In terms of regulating emotions, you can try the following methods: deep breathing, crying, exercise or games, talking, etc. Crying is a good way to vent emotions. Howling or sobbing can help release emotions and relieve stress. Psychologists have done experiments and found that tears produced by emotional fluctuations contain catecholamines, which excrete substances that damage physical health through tears. For negative emotions of the body and mind, find a reasonable way to vent them. If you find it difficult to get out of it, you should seek help from psychological professionals in time.

Author: Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine

Emergency Critical Care Department

Han Dan Wang Xuemin