- Broken Heart Syndrome: description
- Broken Heart Syndrome: Symptoms
- Broken Heart Syndrome: Causes and Risk Factors
- Broken Heart Syndrome: Examinations and Diagnosis
- Broken Heart Syndrome: Treatment
- Broken Heart Syndrome: disease course and prognosis
The Broken-Heart Syndrome (Tako-Tsubo Cardiomyopathy) is a sudden onset of heart muscle disease that is triggered by great emotional stress. Affected persons have similar symptoms as in a heart attack with concomitant heart failure. In contrast to many other heart muscle diseases, this form heals completely in most patients after a few weeks. Read all about Broken Heart Syndrome here!
ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in doctor's letters or on incapacity certificates. I42
Causes and risk factors
Examinations and diagnosis
Disease course and prognosis
Broken Heart Syndrome: description
Broken Heart Syndrome is a sudden, severe stress disorder of the left ventricle. They are among the primary acquired heart muscle diseases (cardiomyopathies).
So it affects only the heart and is not innate, but occurs in the course of life. Other names for the disease are stress cardiomyopathy and Tako-Tsubo cardiomyopathy or Tako-Tsubo syndrome.
Most Broken Heart syndrome is initially thought to be a heart attack because it causes the same symptoms. In the big difference, however, there is no occlusion of a coronary artery in those affected. Although Broken Heart Syndrome is less life threatening than a heart attack, serious complications can still occur.
Who is affected by Broken Heart Syndrome?
Tako-Tsubo cardiomyopathy was first described in the 1990s and has since been studied only in small groups of patients. Therefore, there are still no large amounts of data that could be used to determine the frequency and distribution of the disease.
However, Broken Heart Syndrome is much more common in women than in men. In many cases it is older women after the menopause. Initially, it seemed that this type of heart muscle disease was occurring mainly in Asia, and it has now been observed worldwide.
It is estimated that two percent of all patients, and as many as 7.5 percent of women admitted to hospital with suspected heart attacks, have Broken Heart Syndrome.
Broken Heart Syndrome: Symptoms
The symptoms of a broken heart syndrome are indistinguishable from those of a heart attack. Those affected suffer from shortness of breath, feel a tightness in the chest and sometimes even have the strongest pain, which is also known as annihilation pain. Often the blood pressure drops, the heartbeat accelerates and there are sweats, nausea and vomiting.
Due to the impaired function of the heart, complaints of heart failure often occur. For example, the blood traps back into the lungs and venous vessels because it can no longer be sufficiently pumped into the circulation by the heart. The result can be fluid retention (edema) in the lungs and especially in the legs.
Although the mechanism leading to the symptoms is completely different from that of heart attack, Broken Heart Syndrome can also be associated with serious, sometimes life-threatening, complications. For example, in a small part of those affected massive heart arrhythmias occur, which in the worst case trigger a sudden cardiac death.
In the case of pronounced pumping weakness of the heart, a so-called cardiogenic shock can also develop. The blood pressure then drops so much that the body is no longer sufficiently supplied with oxygen. Without timely treatment, this complication is often fatal.
Broken Heart Syndrome: Causes and Risk Factors
In most cases, the Broken Heart syndrome is preceded by a great emotional burden. This can be, for example, separations or the death of a loved one, which explains the name of the disease. Traumatic events such as natural disasters or violent crimes as well as life-threatening situations, such as job losses, are possible triggers.
Recent research has also shown that even positive stress can cause Tako-Tsubo cardiomyopathy. Joyful events such as a wedding, a birthday or a lottery win are therefore also possible reasons for this form of heart muscle disease, albeit much less frequently than negative stress.
How exactly an emotional burden leads to a dysfunction of the heart muscle and the physical symptoms of a heart attack, is not yet fully understood. However, in many patients with a Broken Heart syndrome, elevated levels of certain stress hormones in the blood can be detected.
For example, so-called catecholamines such as adrenaline and norepinephrine are increasingly released by the body. Researchers suspect that the stress hormones act on the heart muscle and lead there to circulatory disorders and cramps.
Female sex hormones (estrogens) have a protective effect on the heart. As their concentration in the blood decreases after the menopause, this is a possible explanation for the fact that especially older women are affected by a Broken Heart syndrome.
Broken Heart Syndrome: Examinations and Diagnosis
Since it is initially not possible to distinguish a Broken Heart syndrome from a heart attack, one always starts with a patient with the corresponding symptoms of a heart attack. Therefore, a doctor must perform a comprehensive diagnosis as soon as possible, with the help of which he can detect or rule out a heart attack.
A Broken Heart Syndrome shows some similar results in the examinations, but also shows significant differences:
Ultrasound examination of the heart (echocardiography) usually reveals a typical movement disorder of the left ventricle in the area of the apex of the heart in Broken Heart Syndrome. The musculature appears there very little mobile (Akinese). Thus, the alternative name of the disease came about:
At the end of the heartbeat (Systole), the heart looks like a pitcher with a short neck. This shape is reminiscent of a Japanese octopus trap called "tako-tsubo".
As a result of the often resulting heart failure can also often detect an accumulation of fluid in the lungs by means of echocardiography. A heart attack can present itself in a similar way and therefore can not be excluded on the basis of echocardiography alone.
Also on the ECG, the curve in stress cardiomyopathy is similar to a heart attack. Namely, there are changes in the electrical heart activity, as they are typical for a hypoxia of the heart muscle. However, these changes usually show up in all the curves (leads) of the ECG and not just for a specific heart muscle area, as is usually the case with a heart attack.
As in the case of a heart attack, the concentrations of certain enzymes such as troponin T or creatine kinase (CK-MB) in the blood rise after a few hours. However, the climbs are usually lower than during infarction.
This procedure can be used to show if and how well the various coronary arteries are perfused. While one or more coronary arteries are blocked in a heart attack, in a Tako-Tsubo syndrome there is no closure of a coronary artery. Angiography is therefore a good way to differentiate between the two diseases.
Magnetic Resonance Imaging (MRI)
Special magnetic resonance imaging techniques (cardiac MRI with stress MRI) can also be initiated by the doctor. With these methods, he can detect circulatory and movement disorders of the heart muscle and simultaneously represent scarring of the muscles, which would be typical of a recent heart attack.
In an interview with patients with acute heart problems, the doctor is particularly interested in the symptoms and whether the event was preceded by an intense emotional stress situation. If this is not the case, Broken Heart Syndrome is unlikely.
Broken Heart Syndrome: Treatment
At present there is no single scheme for the treatment of Tako-Tsubo cardiomyopathy. Because it can lead to life-threatening complications, especially in the first few hours, one should monitor the patients for some time in an intensive care unit.
The effects of stress hormones can relieve certain medications such as alpha or beta blockers. They reduce the heart burden. Also cardiac arrhythmias and any symptoms of heart failure can be treated with appropriate drugs.
Read more about the investigations
- Cardiac catheterization
Broken Heart Syndrome: disease course and prognosis
Of all myocardial diseases, Tako-Tsubo cardiomyopathy has the best prognosis. Often the symptoms go back in the first hours. Only rarely do complications or lasting damage to the heart arise.
In most patients, heart function normalizes completely after a few weeks. The Broken-Heart Syndrome then heals without further consequences.
Read more about the therapies
- ICD implantation