Researchers say the potentially lethal effects of emotional stress are well known in folk wisdom, as demonstrated by the phrases "scared to death" and "broken heart." But new evidence shows that broken heart syndrome may be an actual medical condition brought on by a surge of stress-related hormones that temporarily "stun" the heart.
The study suggests that people who have broken heart syndrome may often be misdiagnosed as having had a heart attack when they've actually experienced something else called stress cardiomyopathy, which doesn't cause permanent damage to the heart.
Researchers say some people may react to sudden, extreme emotional stress by releasing large doses of stress hormones and other chemicals into the bloodstream. These chemicals can be temporarily toxic to the heart and stun the muscle, producing symptoms similar to a heart attack, like chest pain, fluid in the lungs, and shortness of breath.
"After observing several cases of 'broken heart' syndrome at Hopkins hospitals -- most of them in middle-aged or elderly women -- we realized that these patients had clinical features quite different from typical cases of heart attack, and that something very different was happening," says researcher Ilan Wittstein, MD, assistant professor at The Johns Hopkins University School of Medicine, in a news release. "These cases were, initially, difficult to explain because most of the patients were previously healthy and had few risk factors for heart disease."
The results of the study appear in the Feb. 10 issue of The New England Journal of Medicine.
In the study, researchers evaluated 19 people who were admitted to the hospital after suffering chest pain or symptoms of heart failure after experiencing emotional stress. Eighteen of the 19 patients were women and their average age was 63.
All of the participants had evidence of what was an apparent heart attack after sudden emotional stress, including news of a death, shock from a surprise party, fear of public speaking, armed robbery, a court appearance, or a car accident.
But unlike in heart attack patients, researchers found these people had no evidence of blockages in the arteries supplying blood to the heart. Blood tests also didn't show elevated levels of muscle proteins typically released after a heart attack from damaged heart muscle.
Magnetic resonance imaging (MRI) also showed that none of the emotionally stressed patients suffered from permanent damage to the heart muscle.
But researchers say the biggest surprise was that the recovery rates among people with broken heart syndrome were much faster than those seen after a heart attack. These patients showed dramatic improvements in their heart's pumping ability within a few days and had complete recovery within two weeks. Recovery after a heart attack can take weeks or months because the damage to the heart muscle is usually permanent.
When researchers compared the levels of stress hormones in broken heart syndrome patients to those who had an actual heart attack, they found stress hormones were two to three times higher in the broken heart group. This suggests that the surge of stress hormones may play a critical role in this condition.
"Our study should help physicians distinguish between stress cardiomyopathy and heart attacks," writes Wittstein. "And it should also reassure patients that they have not had permanent heart damage."