Dec. 17, 2018 -- The loss of a spouse. The loss of a pet.
Researchers have confirmed in recent years what people long suspected: Extreme stress can literally break your heart. And as they learn more about the relatively rare condition, they are finding that it’s not only caused by the loss of a loved one. Medical treatments, job loss, and other major life stressors have been linked to the condition.
The syndrome, known medically as takotsubo cardiomyopathy, mainly affects women. While the medical literature on broken heart syndrome is sparse, more cases are coming to light, with additional information about how it happens and how long-term the risks are.
Over a 6-year period, researchers from MD Anderson Cancer Center in Houston found 30 patients having cancer treatment fit the criteria for broken heart syndrome. Fortunately, none had a recurrence, but the researchers say the diagnosis should be considered in cancer patients who get chest pain.
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.
That’s what happened to Joanie Simpson, 63, who had broken heart syndrome 2 years ago after the death of her beloved Yorkshire terrier, Meha.
Meha’s death was just one of many challenges Simpson had at the time. Her husband was about 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.
Her decline was difficult to watch. And after she died, Simpson thought she was coping, but a few days later, she woke up with chest and shoulder pains, fearing the worst -- a massive heart attack. At the hospital, her doctor, Abhijeet Dhoble, MD, a cardiologist at Houston's Memorial Hermann Heart & Vascular Institute, did too.
After running some tests, he found a different cause of her pain: a broken heart.
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.
Often, a patient has many things happening at once, "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."
Dhoble published a study in The New England Journal of Medicine about Simpson’s case, which happened in May 2016.
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. Nor is it always centered on a health issue.
"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, 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. Decker says it got that name because when it happens, 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.
What’s the Risk?
The news is not as good for people who get complications, which affect about 1 in 10 cases. One example is cardiogenic shock, which happens when the heart can't pump enough blood to the body.
A team of researchers studied the records of about 198 people with broken heart syndrome who got cardiogenic shock, comparing them to 1,880 people with the syndrome who did not. Davide Di Vece, MD, a researcher at the University Hospital Zurich, says that while only 2.3% of those without the complication died while in the hospital, 23.5% of those with it did. Those with the complication were also more likely to die within 5 years of the event than those who had no complications, he says.
There is no specific guideline for treating these patients, Di Vece says, so each needs to be evaluated individually and monitored closely long-term.
Prevention Is Key
Stopping stress, or managing it, before the overwhelming stage is, of course, the best advice.
But doing that can be complicated and difficult. Joanie Simpson acknowledges that she learned that the hard way.
At her 1-year follow-up, she checked out fine. Now, more than 2 years later, she is following medical advice closely to stay healthy. "I'm still taking the meds prescribed by Dr. Dhoble and doing very well," she says. "Other than the aches and pains of a 63-year-old grandmother, I am feeling really good and enjoying retirement with my husband out here in the Texas Hill Country."
And has another tiny dog stolen her heart? Not yet, she says. "But we still have Buster, our cat." She and her husband talk about getting another dog, but right now, they plan to do some more traveling. "We are not sure what our next destination will be," she says. "We are just looking forward to what God has in store for us next."