Oct. 25, 2017 -- When Joanie Simpson woke up with chest and shoulder pains one morning, she feared it was a heart attack.

And when she got to the hospital, her doctor, Abhijeet Dhoble, MD, a cardiologist at Houston’s Memorial Hermann Heart & Vascular Institute, did, too.

But tests showed there was a different cause of her pain: a broken heart.

In Simpson’s case, the event wasn’t triggered by the death of her spouse -- who was at her side at the hospital -- but by the death of her beloved Yorkshire terrier, Meha.

Broken heart syndrome is known medically as takotsubo cardiomyopathy. When a patient’s heart “breaks,” the main pumping chamber, the left ventricle, weakens, leading to pain and shortness of breath. The condition is reversible and temporary but can lead to complications similar to those after a heart attack. Experts think it’s caused by a flood of hormones (such as adrenaline) produced during a stressful situation that "stuns" the heart.

Dhoble published a study in TheNew England Journal of Medicine about Simpson’s case, which happened in May 2016.

Simpson, a retired medical transcriber familiar with medical terms, says she felt "a flood of relief" when she heard she didn’t have a heart attack. "I think I remember saying, 'Thank you, Lord.' "

Her own father had died of a massive heart attack when she was just 17, so she was thinking the worst. "He wasn't there at my high school graduation," she says.

Simpson’s relief was actually misguided as broken heart syndrome can be just as deadly as a heart attack.

Stress Piled Onto Stress

Simpson, 62, says Meha's death was one of many challenges she had at the time. "My husband was fixing to retire," she recalls. The sale of some property wasn't going smoothly. Her son was dealing with worsening back problems. Her son-in-law lost his job.

Then little Meha, whom the couple had adopted when she was just a year old, was diagnosed with congestive heart failure. Simpson asked what could be done. "It was medication upon medication upon medication," she says.

Every other week, the vet needed to drain accumulated fluid. She got worse, and Simpson took her in to be euthanized. Once there, however, she suddenly pepped up. "She was hopping up into my lap," she says, so they went home.

But the next day, Meha died, and not peacefully. It was very difficult to watch. (More than a year later, Simpson still gets choked up.) She thought she was coping, but a few days later, she woke up with severe pain.

Scenario Is Common

More than 6,200 cases of broken heart syndrome were reported in 2012 in the United States, up from about 300 in 2006, says Dhoble. Most patients are women. The increase, he says, is likely because more people know about the condition.

"Most of the time, a bunch of other situations is going on, and something trips them over," Dhoble says. "There is almost always a very distinct stressor. If you ask patients carefully, they will tell you that."

The condition doesn't just happen after a person or a pet dies, says Jeffrey Decker, MD, section chief of clinical cardiology at Frederik Meijer Heart & Vascular Institute of Spectrum Health in Grand Rapids, MI.

"I had a lady who was frustrated with the cable company present with this," he says. Another was a woman who found out her daughter lost her job, says Decker, also an assistant professor of medicine at Michigan State University.

Severe pain can trigger the syndrome. So can an asthma attack, getting bad health news such as a cancer diagnosis, a fierce argument, a surprise party, or even public speaking.

Symptoms mimic a heart attack -- most often, chest pains and shortness of breath. Nausea, vomiting, and palpitations can also happen. But only testing can show the diagnosis, says Dhoble.

"Takotsubo" means “octopus pot" in Japanese. It's so named, Decker says, because when a doctor notices the condition during testing, certain portions of the heart muscle do not move well. Other parts make up for that lack of movement, making the heart look like a pot used by Japanese fishermen to trap octopuses.

About 95% of patients recover within a month or two. "Usually the prognosis is quite favorable," Decker says. Patients usually get the same medications used to treat congestive heart failure to support and strengthen the heart. Death is uncommon in people who don't have complications, with less than a 3% fatality rate.

Postscript: Joanie Simpson

At her 1-year follow-up, Simpson checked out fine. People who have had the condition once are more prone to getting it again, but Simpson is taking heart medications and says she has had no other problems.

But she does have a new outlook. "I (used to) let things get to me and pile up instead of saying, 'Lord, I am turning this over to you.' " Her advice to others? "Yes, you are going to have stresses, but don't get to that point where you think you have to deal with everything. Don't let every little thing weigh on you."

Show Sources

Jeffrey Decker, MD, section chief, clinical cardiology, Frederik Meijer Heart & Vascular Institute, Spectrum Health; assistant professor of medicine, Michigan State University College of Human Medicine, Grand Rapids.

Abhijeet Dhoble, MD, cardiologist, McGovern Medical School, UTHealth and Memorial Hermann Heart & Vascular Institute-Texas Medical Center, Houston.

Joanie Simpson, 62, Camp Wood, TX.

The New England Journal of Medicine: Oct. 19, 2017.

The American Journal of Cardiology: October 1, 2015.

Harvard Women's Health Watch: "Takotsubo cardiomyopathy (broken-heart syndrome)."

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