Understanding Broken Heart Syndrome: What You Need to Know About Stress Induced Cardiomyopathy

Hello, I'm Dr. V. Welcome and thank you for joining us today. We are going to talk today about uh a syndrome called broken heart syndrome. If you've never tuned into our show before, I'm I'm a board certified emergency medicine physician and we do this show weekly. I'm committed to really empowering you with life-saving health information. Do me a favor and make sure to uh download and subscribe to the podcast, What the Health Is Happening. Um, this is where we have all of the health content that we actually provide on a weekly basis. And make sure to comment and follow me on social media. So today we're going to talk about broken heart syndrome. And a lot of people didn't realize that this is actually a real medical condition. So let me actually explain this. So when you have a short-term physiologic stress, and usually it's grieving from the loss of a partner, it could be a very short-term or significant medical problem or financial problem that occurs, it actually can impact your heart and it can lead to broken heart syndrome. There's other names for it, um stress-induced cardiomyopathy, and the other name for it is takasubu cardiomyopathy, which we call in the medical profession TTS. So what happens is something occurs, whether or not it's a loss, a death of a family member, um, a shock, a financial distress, or an illness, um, and it leads to a sudden rush of adrenaline. And uh adrenaline impacts your heart. And so your left ventricle and your left ventricle, which is the main pumping of your heart, becomes stunned and it doesn't begin to contract normally. Um, but what happens is it really impacts the bottom part of your heart of your ventricle, and less so the top part of your ventricle. And so it leads to your heart kind of almost looking like a boot or um or kind of like a blob at the bottom, um, and it's kind of bigger and wider than it normally is. Um, the word takasubu in Japanese means octopus trap, um, and that's because their octopus traps look very big and bloated at the bottom. So what happens is your ventricle isn't contracting very well, and your your heart is temporarily um not pumping as efficiently. And we say temporarily, but for some people, in rare cases it can become permanent. But when we say temporary, this can go on temporarily for weeks or months. It often isn't permanent, but in rare cases, again, it can be. So, how would you know if you actually had this? So, people do develop symptoms from this. They can get chest pain, uh, shortness of breath, they can get irregular heartbeat, they can also get fainting. And usually what happens is the best recommendation is to go to the emergency department if you're having these types of symptoms, and there you will have a physician that will actually check you out with an EKG and labs. They will make sure that you are not actually having a heart attack. And so a heart attack is much different than this type of uh cardiomyopathy because with a heart attack you have clogging of your coronary arteries, and with takasubu cardiomyopathy or stress-induced cardiomyopathy, usually the person has very clean coronary arteries because that is not really the thing that is causing the problem. What is causing the problem is the rush of adrenaline that has occurred as a result of either the loss or the financial stress or the medical stress or usually the recovery is um days to weeks, um, and then it takes that long sometimes for the cardiac function to actually come back to normal. It can be misdiagnosed as a heart attack, or people may feel like they're having a heart attack. Um, but again, when you go to the doctor and you get all of the tests run, you'll find that there are no blocked coronary arteries, um, and everything seems to look normal as far as that's concerned. Um so one of the things that we find is that women are more likely to be inf affected by Takasu B cardiomyopathy or stress-induced cardiomyopathy. Um, in fact, they find that, you know, 80% of the cases usually involve women, and 20% of the cases involve men. Um, we're not exactly sure why that happens. There's still a lot of research going on around that. But again, the risk factors for this or any sort of um major financial loss, major medical diagnosis, it may also be a major loss in your family, like the loss of a a husband or a wife or a very good friend or a parent. Um, in very rare cases, the cardiomyopathy is permanent, and also in very rare cases it can be uh fatal. So it's really important that if you have these symptoms that you actually go to the emergency department and get checked. So please join us in on this conversation. And if you have some questions and you would like to get your questions answered, you can call me at 1-800-450-7876. 1-800-450-7876. You can also email me at info at asdrv.us. That's info at asdrv.us. All right, what the health is happening? That's a real question. It's also the name of my new podcast where you can literally get life-changing medical information. What the health is happening is where we give you the inside scoop on all health matters and empower you with information on everything from breaking news to health and medical updates. What the health is happening is your dose of medical reality with me, Dr. V and my friends from the front lines of healthcare. And it can be heard on all podcasting platforms. Please make sure to download, subscribe, and comment. I want to hear from you. This show is really curated by your questions and by your emails. And I try to actually have topics that are on things that my audience actually wants to hear. So please download, subscribe, and send me your comments. Alright, I've got a question from Anita, and she wants to know with this stress-induced cardiomyopathy, is there a cure and how can the heart heal itself? So there's not really a cure. Your body kind of gets over it. And so what happens is that this cardiomyopathy or heart failure in some situations is related to the heart muscles being stunned from the high amount of adrenaline that is actually being released. And what happens is the heart muscle itself is still alive, it's just not functioning like it normally does. So over time the adrenaline levels go back to normal, and then when those levels go back to normal, then the heart begins contracting and pumping normally. So that is how the heart sort of heals itself from this particular insult. It is very, very different from having a heart attack where the heart actually, where the heart cell actually loses oxygen and nutrients and actually dies. In in Takasubi cardiomyopathy or stress-induced cardiomyopathy, there is not cellular death. It is just not working as well as normal because of the high amount of adrenaline associated with whatever the original insult is. So there is no cure. Your body actually takes care of it over time, and that is how the heart heals itself. Alright, great question. Um I've got another question here from Kelly. She says, Dr. V, if estrogen protects the heart against the damage stress hormones cause, why are postmenopausal women most vulnerable? How should this influence conversations black women have with their physicians as they approach and go through menopause? So a couple things I would say to this question is one is um this really impacts um all women, not just black women. So we see Takasubu cardiomyopathy and um or stress-induced cardiomyopathy in all women. And again, I have actually seen it in men. So I don't want people to think that it is not in men. It is just more likely to actually be occur um occur in in women. So one of the things that we find is that hormones, particularly estrogen, is very cardioprotective. And so it's protective of not only the blood vessels, but also the um heart cells. It really helps uh blood vessels relax. Estrogen really helps blood vessels relax and it improves the the function of the actual uh blood vessels. And so when estrogen drops after menopause, the heart becomes more sensitive to stress-induced damage or stress-induced hormones like adrenaline. Um there have been uh animal studies done where they have removed um estrogen and then the animals have become more susceptible or more likely to actually get uh takasubu uh like heart dysfunction, and then when they replace the estrogen, um there is some protection. However, we haven't seen those same studies in women. So we haven't seen in the human population, so we haven't seen where necessarily we provide uh estrogen products to women uh that are post-menopausal and therefore they become less likely to have takasubu uh or stress-induced cardiomyopathy. Those studies have have we have not seen studies that have been done that have shown that to date. That would have to be a very long longitudinal study. I think if you're looking at estrogen and estrogen replacement, that is a conversation to have with your physician. And I wouldn't really focus on uh stress-induced cardiomyopathy because you don't know when you're actually going to be stressed. These are usually sudden, these are usually sudden stressors like a sudden death or a sudden financial loss. These are these are not usually things that you may foresee coming in the future. But I think that when you talk about um uh hormone replacement in women that are postmenopausal, there are a lot of different uh protective factors uh related to that. And you need to really speak with your physician about whether or not that is something that works for you when they go over all of your all of the your past medical history and also your family history and sort of see whether or not that is something that actually works for you. Thanks. All right, Millie asks a question. Dr. V, how does knowing that grief and heartbreak physically deform the heart or or make the heart not function well, even temporarily, affect how we should process emotional pain? Um so, uh Millie, this is a really great question. It I don't think necessarily that we have to change how we process um emotional pain. I don't think you can really um adjust how you process it and therefore impact whether or not your body does or does not actually excrete uh adrenaline. I think what we have to just more be cognizant and be aware of is that this can happen, right? Um and there are things that occur in our lives that are very unanticipated, um, whether it involves family or money or or your job. And so it's just it it's really important during these time periods to realize that your body is going through a temporary high stress time. You may or may not get stressed and cardiomyopathy, but even if you don't have symptoms like that, chest pain and shortness of breath, to really understand that you're going through a stressful period of time. And how do you actually care for yourself during that time period? How do you be gentle with yourself? How do you make sure you take some take some walks? How do you make sure you reach out to people? How do you make sure you journal? Um, making sure that you really have a support system around you. I notice, particularly with grieving, there's often a period of time where there's a lot of people around, a lot of people coming by the house, and then after the funeral, there's almost silence. And so it can be very lonely. Um so I just remind people, you know, if you have folks in your lives that have experienced something that is stressful, um reach out to them more than once and allow them the opportunity to talk through it. Um, the social support that we provide to each other is really, really critical during these time periods. Thanks for the question. All right. I've got a question and it's from Janice, and she says, Dr. V, if you or someone you love had these symptoms after emotional trauma, would you go to the ER? Why do you think we uh a lot of a lot of black Americans often delay seeking emergency care? So great question, um uh Janice. It's it's funny, I see all people delaying medical care, and so I always tell people, I'd rather have you come to the emergency department and see us, um, and um, you know, if it's okay, get some sort of uh reassurance. Um I so I think it's it's it's interesting. I think that a lot of times after emotional trauma, whether or not again it's loss or financial hardship or whatever it may happen to be, um, a lot of people think that um they should feel ill or sick afterwards. And certainly you are going to feel sad, um, certainly are you gonna have some emotions. Um and I but I think it's very, very different when you talk about I'm having chest pain or I'm having shortness of breath or I'm fainting. Those are situations where people actually do really need to go to the emergency department and seek medical care. Um I think a lot of people um see some of these things as just the normal reaction, and they're not normal when they actually reach these extremes of symptoms. Again, you know, with with the loss of someone that you love or with a significant financial loss, you certainly can feel sad. I think I would draw the line uh if you are fainting or having chest pain or having a shortness of breath. Um, those types of symptoms are really, really important to actually get medical treatment. Great question. All right, I've got a question here from Connie, and she says, Many people have chest pains after devastating loss and breakup, and they think it's anxiety. After learning about broken heart syndrome or stress-induced cardiomyopathy, how does it change the way you think about heartbreak as a physical experience, not just an emotional one? Furthermore, how can we tell the difference? How can we tell the difference between the two? So, personally, people, um, when they're just experiencing these symptoms, they cannot really tell the difference. They really have to go to the emergency department to actually get treated. We actually can see the difference. We can one see the difference on your EKG. Um, we can also see the difference when we actually draw lab tests. Sometimes we can actually also see it on the chest x-ray. So there's a lot of different ways in which we can see it. May in the emergency department know that the heart is under some sort of strain or stress. We may not know whether or not it's related to an emotional loss or a stress-induced cardiomyopathy until someone actually does either a cardiac catheterization or maybe it's a stress test. There's certain things like that that'll actually tell us that this is actually related to a stress-induced cardiomyopathy as opposed to a coronary artery disease. So I think it's really important that you get into the emergency department and you actually are seen by a cardiologist once you're actually admitted, and then they can actually run all the testing to actually determine what is what is actually happening. What is important though is that if you have stress-induced cardiomyopathy, the good news is that usually people make a complete re recovery from that without too much intervention or treatment. Time itself will often resolve that. It's very, very different if you have coronary artery disease and if you've had a heart attack, or if you have some blockages in your coronary artery, which then may need stents or surgery or something that is more complicated as far as treatments. So I think it's really, you know, awareness is the first part of this and actually knowing that this is not normal to have chest pain and shortness of breath and fainting as a result of a loss. So thank you for the question. All right, I got a question from Andy, and this is a this is a really great question. All right, Andy's asking, uh, Dr. V, when you talk about this stress-induced cardiomyopathy, you're talking about financial loss and people grieving and losing loved ones. Can happy events trigger uh stress-induced cardiomyopathy as well? So great question, uh, Andy, and the answer is yes, it can. So um happy or exciting events, um, particularly ones that lead to a huge adrenaline rush, can also cause takasubi or stress-induced cardiomyopathy. So it does not have to be just a a loss. I think that um after a loss is when uh people will uh recognize it more, but it certainly can occur as well with an um extremely happy event because your body in general doesn't really know the difference between a happy event or a sad event. All your body knows is it's having a very stressful, acute event that's going on, and it actually releases adrenaline, and that short burst of adrenaline is actually what causes stress-induced cardiomyopathy. So, happy triggers for stress-induced cardiomyopathy could be things like a surprise birthday party or celebration, uh, winning a lot of money at a lottery, a wedding, uh, birth of a grandchild, um, a big sports victory, um, some any sort of unexpected good news. So, yes, unexpected good news or unexpected bad news, your body doesn't notice the difference. It sends out the adrenaline, um, and then when it sends out the adrenaline, you can get stress-induced cardiomyopathy. Thank you for the question. Another question I I've got from a uh a caller is you know, if I have stress-induced cardiomyopathy, does that mean that I am more likely to have a heart attack or have some sort of heart condition uh afterwards? So, yeah, so not really necessarily because um the it's very, very different. So, because stress-induced cardiomyopathy is your body's response specifically to the adrenal hormone, it really doesn't correlate with whether or not you're gonna have coronary artery disease in the future. It's really um two different things. Now, if you have chronic stress, that can increase your likelihood of having coronary artery disease later on. But but stress-induced cardiomyopathy is really related to an acute stress that actually that actually occurs as again related to happy news or bad news. Um, and so no, we don't really find that it is correlated with having having uh heart disease, traditional coronary artery disease uh in the future. So uh I've got another question here and it's from Angie, and Angie is saying that her mother had stress-induced uh cardiomyopathy after her father died, and she is wondering whether or not her mother is more at risk at having it again if someone else in the family dies. So, yeah, so so once you have stress-induced cardiomyopathy once, it actually does slightly increase your chance of having it again. But again, I I don't I don't it's not guaranteed, right? So I think people in general they find that about five to ten percent of patients experience another episode at some point in their life. And that recurrence can happen either months or uh years later. And again, the the trigger can be an emotional stress, a physical stress. Sometimes it can be no trigger at all. Um, it can be happy or sad, and it will follow the same similar pattern in that usually the person will have similar symptoms, um chest pain, shortness of breath, fainting. Um, they will have it for weeks to months, and it will normally reverse itself. Um, and so I think it's really important if you've had this once, to really make sure that you have a stress management plan. Um, it is really, really important to actually keep yourself as grounded as possible if you've had this once, because you can actually have this uh more than once. And I have seen patients that have had uh stress-induced cardiomyopathy uh more than once. So great question. I've got a question here from Ben, and Ben is asking, uh, when you have stress-induced cardiomyopathy, uh, Dr. V, what do you actually see on the echocardiogram? Um, so this is really this is really a great question. Um so so when you're so when we're doing an echo on a patient's heart and we actually and they actually have takasubi, uh, what we see is kind of like a, I would describe it as almost like a balloon of a heart. It's kind At the bottom is a balloon and it's not really contracting well. And then at the top of the heart, it's actually contracting normally. So it kind of looks like a boggy heart at the bottom. And then at the top, it actually looks almost normal. So seeing those two things right next to each other in juxtaposition to each other actually is what usually and knowing the history from the patient around what is actually happening makes you actually have a high suspicion for stress-induced cardiomyopathy. The other thing that happens sometimes in patients is that they may have just had a recent cardiac catheterization, and we know that their coronary arteries are clean. So that's also very helpful in making the diagnosis. And lastly, there's certain EKG findings that we see on the EKG that leads us to actually kind of suspect it along with the history. And again, definitively is when they actually do the cardiac catharization. The cardiac catharization shows that the coronary arteries are clean. And then over time the cardiac function begins to come back. And all of those constellations of symptoms and analysis actually lead to the diagnosis of stress-induced cardiomyopathy or takasubu cardiomyopathy. Alright, we've got another question here, and this is a question from Karen, and she wanted to know: are there any medications and stimulants that can trigger or cause stress-induced cardiomyopathy? You talked a lot about events, but Dr. V, we want to know if there's any medications or stimulants that can cause it. So, yes, there are. There are certain medications and stimulants that actually increase the stress hormone in your body and then cause you to have takasubu or stress-induced cardiomyopathy. Specifically, if some people actually are taking or or may get in the emergency department related to an allergic reaction, they may get epinephrine, which is an adrenaline, or norepinephrine, which is also an adrenaline, and that can cause it. Other things that can cause it is caffeine in very high doses. For those folks that, you know, drink, you know, eight, ten cups of coffee a day. Also, you can see it with amphetamines and cocaine. We can also see it uh with uh asthma inhalers that are overused in the outpatient setting. Um, and some antidepressants and uh decongestants can also make it occur because they also have stimulants in it. Anything that's a stimulant or that will actually lead to adrenaline release in your body, um, whether or not it's an event or or a medication or um a stimulant like caffeine or coffee or tea or over soda, dark sodas, uh anything like that can actually lead to a stress-induced cardiomyopathy. All right, I've got a question here from Naomi, and she wants to know um can people kind of mistake the symptoms for uh stress-induced cardiomyopathy for anxiety or indigestion? Absolutely, and this is why it's really important that you cannot assume that you have anxiety or indigestion. If you have any sort of chest pain or any sort of symptoms in your epigastric area, sort of in your upper stomach area, um, you can't assume that it's anxiety or a panic attack or indigestion or reflux. You really need to go to the emergency department and actually um get it uh checked out. It can really be a disguise. And so anything that really is causing you chest pain, chest pressure, epigastric discomfort, feeling of burning, shortness of breath, sudden onset of um suddenly getting faint or falling out, it is really, really important to go to the emergency department and get these uh things uh checked out because stress-induced cardiomyopathy and really all sorts of heart disease can mimic other things uh that you may think are more benign. But I always tell people, remember, at home you don't have the tools that we have in the emergency department to distinguish between things that are benign or serious. So it is important better to get it all checked out and make sure because it may be something more serious. Thanks for the question. I want to thank you guys for joining me for this conversation about um the broken heart syndrome or stress-induced cardiomyopathy. Um, I think it's really, you know, it's one of those things that I think a lot of people don't realize can occur that we see in the emergency department and in the cardiologist uh offices uh quite frequently. So I want to thank you guys for joining me today. The mission of Channel of Health is to inform, educate, and empower communities about pressing health and healthcare issues. The Channel of Health also provides scholarship for MCAT Prep and school scholarships for promising scholars majoring in science and medical-related careers. You can support our efforts to educate and empower our community. Go to channelofhealth.org or you can go to askdoctorv.us. If you have a topic that you'd like to hear us talk about, or if you actually have any questions, please make sure to email me or send me an audio message at info at asdrv.us. That's info at askdrv.us. Please also follow me on Twitter, Instagram, and Facebook, and all the other places. 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