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How Common Is 'Broken Heart Syndrome'?

Study Suggests Men as Well as Women Have Condition That's Also Known as Stress Cardiomyopathy
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WebMD Health News

July 19, 2011 -- Stress can stun heart muscle, causing symptoms that mimic a heart attack.

This disorder, which is called "stress cardiomyopathy" or "broken heart syndrome," is most common in older women, typically striking after a major physical strain like surgery or mental hardship like the death of a loved one.

Now a new study, one of the largest of its kind, confirms that stress cardiomyopathy can also affect men and premenopausal women.

And in as many as one-third of cases, a triggering event cannot be pinpointed, suggesting that causes of stress cardiomyopathy may sometimes be too subtle to recognize.

Experts who were not involved in the research praised the study for its size and for its use of cardiac magnetic resonance imaging (MRI) scans to carefully document the physical features of the poorly understood syndrome.

"It was nice that they were able to get a big cohort of patients from different centers and kind of do things all the same way," says Mazen Hanna, MD, a cardiologist who is director of the heart failure intensive care unit at Cleveland Clinic in Ohio. "Kudos to them for pulling that off."

Others agree.

"I think it's the best large-scale study looking at the MRI features of this condition," says Ilan S. Wittstein, MD, a cardiologist and assistant professor at The Johns Hopkins University School of Medicine,in Baltimore.

"This definitely shows, using MRI, that the pathophysiology of this condition is very different," Wittstein tells WebMD. "It clearly separates this from other kinds of heart muscle disorders."

The study is published in the Journal of the American Medical Association.

Documenting Broken Heart Syndrome

Researchers in Germany and Canada identified 256 cases of stress cardiomyopathy between January 2005 and October 2010 from seven different hospitals in Europe and North America.

Patients ranged in age from 30 to 90. The average age was 69.

As expected, most of the affected patients, 81%, were postmenopausal women. But 8% of cases were in women younger than age 50, and 11% occurred in men.

Only two-thirds of study participants were able to identify something that triggered their symptoms.

For 30%, the cause was emotional, and included the death of a friend, pet, or relative, interpersonal conflict, anxiety, anger, or the loss of a job.

For 41% of study participants, the cause was physical. Top physical stressors reported in the study included surgery, breathing trouble like COPD, asthma, or bronchitis, and chemotherapy.

"Despite careful history taking," the researchers write, "only two-thirds of patients had a clearly identifiable preceding stressor."

"Thus, our large multi-center cohort demonstrates that the absence of an identifiable stressful event does not rule out the diagnosis," they conclude, and surmise that the mysterious disorder may have complex underpinnings, involving the endocrine, vascular, and central nervous systems. This suggests the need for enhanced awareness and recognition of this condition to ensure correct diagnosis and management.

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