Broken Heart Syndrome, Real or Imagined

[Debi Fischer]

What does winning the Lotto and breaking up with someone have in common? Also, losing a loved one suddenly or being diagnosed with a fatal illness? Plenty. All these scenarios may precipitate "Broken Heart Syndrome".¹ One type of "Broken Heart Syndrome" which is relevant is Takotsubo syndrome. This means "octopus trap" in Japanese.^{1, 2} The heart has upper and lower chambers and in this case, the heart appears as if it is being captured from below. It then expands as if trying to flee. The death of 1950s icon Debbie Reynolds in December 2016 one day after the death of her daughter, actress/writer Carrie Fisher brought this health concern to the public spotlight.³ Although Ms. Reynolds was 84, this syndrome does not just affect the elderly. In her case, this syndrome may have contributed to the stroke that caused her sudden death.³

THE CLINICAL PICTURE

Nurses in the clinical setting may not be aware of or be familiar with this syndrome. Clinically speaking, after a shock to the system, the heart responds by expanding or enlarging while at the same time contracting or working harder. This does not last forever and is a temporary problem. It can, however, cause failure of the heart, which is a muscle, in the short term. ^1,2,3 The patient may have severe chest pain or shortness of breath (sob). Stress hormones like adrenaline and the patient's response to them are the culprit in this scenario. This is also known as apical ballooning syndrome or stress cardiomyopathy.^{1,2, 3}

SCENARIOS

Other scenarios this may occur in are a divorce, even having to speak in front of an audience, known as stage fright, as well as domestic violence and losing a job. The list of possible scenarios is lengthy, but the main common denominator is stress. By now, you may be wondering if you might be the next victim of "Broken Heart Syndrome".

RISK FACTORS

What if I finally win the Lotto, or my significant other dumps me? Am I better off not playing every week or not dating or marrying anyone? In an effort to clear up any confusion, there is a list of risk factors RNs can familiarize themselves with just to be on the safe side. They are as follows: history of a previously diagnosed neuro condition, being female, over 50 years of age, and having a psychiatric problem.¹ Patients who have been diagnosed with epilepsy, for example, or who have had a head injury are at greater risk as well as those with a history of anxiety or depression.¹

BROKEN HEART SYNDROME VS. MI

You may be wondering how this differs from an MI or heart attack? That is a great question and some of it can be answered by looking at the arteries. As we all know, blockages in the arteries of the heart may be caused by a combination of poor food choices, high-fat content or exacerbated by smoking. Atherosclerosis is the villain in this scenario. In "Broken Heart Syndrome", this is not the case. There are no blockages, yet the heart is unable to function properly.^1,2,3

Diagnosis of this syndrome will involve an EKG and blood tests. The EKG, for example, will not have elevated T waves, found in an MI and the cardiac enzymes, a marker for a recent MI will be negative. The left ventricle will balloon. An echocardiogram may also be done especially after the episode to further assess any possible damage.²

MEDS AS RISK FACTORS

There is also a short list of medications which infrequently cause "Broken Heart Syndrome". This is due to an influx of stress hormones which can trigger it. The four drugs listed are Epinephrine (EpiPen, EpiPen Jr.). Ironically, this drug is used during an out of control asthma attack or allergy attack. Asthma attacks are one cause of "Broken Heart Syndrome". The other three are Duloxetine (Cymbalta), and Venlafaxine (Effexor XR) or depression and Levothyroxine (Synthroid, Levoxyl), used for hypothyroid disorder. Cymbalta is also used in patients with diabetic neuropathy.¹

RECOVERY

As in the case of screen legend Debbie Reynolds, this can indeed cause death. The good news is this is not a likely scenario. If someone is diagnosed with this disorder, they usually will recover, however, it may take a few weeks. It usually does not strike twice.

Complications may ensue, however, such as pulmonary edema, which causes swelling in the lower extremities and difficulty breathing due to fluid overload in the lungs as well as low blood pressure or hypotension.¹

Management of this syndrome by a healthcare provider may lie in the mental health as well as cardiac specialties. Learning to let go of problems and reducing stress, in general, may be a key factor here. Also, a physician may prescribe a beta-blocker in order to prevent future episodes.¹ This may help with stopping the influx of stress hormones that are the cause of the problem.

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References

1. Broken heart syndrome - Symptoms and causes - Mayo Clinic Mayo Clinic Patient Care and Health Information Published 2018. Accessed July 10, 2018.

2. Is Broken Heart Syndrome Real? American Heart Association Is Broken Heart Syndrome Real? Published 2018. Accessed July 10, 2018.

3. Did Debbie Reynolds Die of a Broken Heart? Benedict Carey December 29, 2016

Did Debbie Reynolds Die of a Broken Heart? - The New York Times

Accessed July 10, 2018.

[FolksBtrippin, BSN, RN]

Change the title please.

This is not a discussion of whether or not broken heart syndrome is real.

[Debi Fischer]

Thank you for reading the article.