Understanding Broken Heart Syndrome 💔

While I was at the hospital yesterday to check my Blood Pressure as I do during the weekend, as well as explain to my doctor about how I feel my heart beats heavily whenever I do something stressful or when I am emotionally down. He laughed, and said he hopes I do not end up having broken heart syndrome when I am in a very emotional position, I laughed and said it wasn't possible, (actually, he was joking), but sincerely between you and me, I know that, it is slightly possible that I could develop broken heart syndrome if I reach a breaking point with my emotions. One thing I know for sure is that I am very emotional, and it could be a reason why I have this heavy heart beat whenever I am working, thinking, or doing anything emotional. In my previous post A Hypertension Experience and Research, I talked my experience with heightened blood pressure whenever I am working or emotional, you should read the post haven't. Now, before you start to see me as someone who is emotionally weak or would develop broken heart syndrome, let me explain what Takotsubo Cardiomyopathy / broken heart syndrome really is.

Apical Ballooning Syndrome

So you do not get confused, I am referring to the same Broken Heart Syndrome. Takotsubo Cardiomyopathy has a lot of alias including; broken heart syndrome, stress cardiomyopathy, ampulla cardiomyopathy, and apical ballooning syndrome. I will be using these words interchangeably in the course of writing this post.

The syndrome, was first described in a Japanese article titled in 1991 by Sato et al. The name Takotsubo is a Japanese word used to describe a container trap for capturing Octopus. The container has a rounded bottom with a narrow neck. Takotsubo is characterized by the swelling of the left ventricle of the heart, thereby causing an impairment of that side of the heart which makes it not pump like the other part of the heart.

Let's do a little anatomy of the heart.

In a cross-section of the anterior view of the heart, the heart is divided into four chambers, the Atria (plural), and the ventricles. The heart comprises two small atria (left and right), and two large ventricles (left and right). The wall of the heart is made up of three layers of tissues, the outer layer known as the epicardium, the middle layer called the myocardium, and the inner layer known as the endocardium. [training.seer.cancer.gov]

In the heart, the superior Vena Cava, and the Inferior Vena Cava is responsible for bringing deoxygenated blood to the Right Atrium which then sends the blood to the right Ventricle through the Tricuspid valve. The Right Ventricle which then pumps the deoxygenated blood to the Pulmonary trunk through the pulmonary valve, The Blood is then pumped to the left pulmonary artery and the right pulmonary artery, after which the blood is then transported to the lungs to absorb oxygen and release carbon(iv)oxide. The Lungs return the oxygenated blood to the left side of the heart through the pulmonary vein, to the left atrium, then to the left ventricle via the Mitral valve, after which the oxygenated blood will be transported to the Aorta through the Aortic Valve which then transport blood to the upper body or to the lower body through the Descending Aorta. NCBI.

Rarediseases.org explains that with Takotsubo Cardiomyopathy, part of the left ventricle which supplies blood to the aorta which then transports to the body get blocked, thereby causing a swelling as a result of the blood not pumping properly to the aorta. This could arise as a result of a short term spasm with the coronary arteries.

Research in 2003, published in the National Library of Medicine, reported that Takotsubo Cardiomyopathy is common among Caucasian who live in Europe and North America. Also, Studies by Gianni et al. published on NCBI shows that Takotsubo Cardiomyopathy is common among post-menopausal women who reported chest pain and dyspnea (breathing difficulty). In addition, research published on the American Heart Journal explains that due to the mimicking attribute of Takotsubo Cardiomyopathy, even with electrocardiogram (ECG), it could be mistaken for acute coronary syndrome such as acute myocardial infarction.

According to a study carried out by Templin et al., in Clinical features and outcomes of Takotsubo (stress) cardiomyopathy, Takotsubo Cardiomyopathy can be triggered both physical and emotionally. The study was done on 1750 patients with 36% of them being triggered by physical stress, 27.7% triggered by emotional stress, 7.8% were triggered by both physical and emotional stress, while 28.5% showed no evident trigger. Emotional trigger could be caused by, but not limited to divorce, death of a loved one, bankruptcy, financial loss and so on, Physical trigger could be caused by, but not limited to stroke, fracture, infection, Domestic abuse, Natural disasters, and Surgery. While these triggers can cause Takotsubo Cardiomyopathy, its pathogenesis is still very uncertain. A hypothesis, published on PubMed by Wittstein et al., links its occurrence to the excessive release of the adrenaline (epinephrine) and catecholamine. The hypothesis shows that catecholamine presence in patients with Takotsubo Cardiomyopathy were two to three times greater.

While Treating Takotsubo Cardiomyopathy, Administering thrombolytic agents (used for clot bursting in heart attack, and stroke) should be avoided NCBI. Treatments should include Beta-Blocker medicine to block the excess catecholamine being produced , Angiotensin-converting enzyme (ACE) inhibitors, and Angiotensin II receptor blockers (ARBs) are used to reduce the workload in the heart, as well as control hypertension if the patient is hypertensive [sciencedirect], other treatment include, Oxygen inhalation therapy, Anticoagulants, aspirin, heparin. In severe cases, mechanical left ventricular support may be needed.

Conclusion

Takotsubo Cardiomyopathy can be diagnosed in both male and female, but it is majorly associated with females, and more specific with post-menopause women. One risk factor to Takotsubo Cardiomyopathy diagnoses, is treating it as heart attack or stroke, most time, emotional support could do well to help the person calm after treatment. If you feel any pain in your chest region, accompanied by breathing difficulty, it is advisable that you call the medical emergency number in your country, or visit the doctor. Do not self-medicate, it is very detrimental.

Image References
Chest pain
The Heart