Broken Heart/Takotsubo – Can you Die from a Broken Heart?

Takotsubo Broken Heart Syndrome

Can You Die from a Broken Heart?

Statistically speaking the answer seems to be yes. A study by Spreeuw and Xu Wang (2008) found that in the year following the loss of a loved one, men were 6 times as likely to die and women twice as likely to die as they normally would be. It is known in medicine that stress plays an important role in an individuals health and thus very severe stress can have significant impacts.

When we consider Stress and the Heart organ itself, we again accept that prolonged stress can have a negative affect on the heart. For example, consider sustained elevated blood pressure and its role in heart disease and cardiomyopathies. If you didn’t know already, sustained high blood pressure can cause you heart problems later in life.
Less known is that a syndrome exists that causes a temporary weakening of the heart muscle called Broken Heart Syndrome 

Why is it called this? because in roughly 65% of reported cases the patient has just suffered a significant stress event – such as the death of a loved one.

Just before I continue there are a few other names that this syndrome goes by (more aliases than an international spy).
  • Takotsubo (Most Common)
  • Transient Apical Ballooning Cardiomyopathy
  • Apical Ballooning Cardiomyopathy
  • Stress Induced Cardiomyopathy
  • Gebrochenes-Herz Syndrome
  • Stress Cardiomyopathy

Takotsubo Broken Heart Syndrome
Takotsubo – Broken Heart Syndrome, Where does it get its name?

The most common name for ‘Broken Heart Syndrome’ is Takotsubo. This translates from Japanese as Octopus Trap. The reason being that the left Ventricle of a patients heart during Takotsubo takes on the appearance of an Octopus Trap commonly used in the country where it was first reported.
In the picture to the right I have traced the outline of a normal Ventricle and one during Takotsubo during an LVGRAM (Kind of X Ray that looks at the Ventricle). The latter is positioned next to an ‘Octopus Trap’ so you can clearly see why it got its name.

What exactly is Takotsubo?

‘Takotsubo’ or Broken Heart Syndrome are well recognised causes of acute heart failure. Patients rapidly develop weak and ineffective pumping of their heart and as a result normally turn up complaining of chest pain and breathlessness. It is one of the causes of Heart Failure that can be completely reversed!
Symptoms occur because the Syndrome causes the bottom (apex) of the Ventricle to become ‘stunned’ . In this state the Ventricle can no longer contract and force blood out of the heart and around the body.
Think of this stunning as a bit like a cramp, we all know how ineffective our muscles are during a cramp! The ‘base’ of the Ventricles shown by these two blue arrows (above), continues to perform as normal but the apex is doing pretty much NOTHING!

What Causes Takotsubo/Broken Heart Syndrome?

In 2/3rds of Patients Takotsubo or Broken Heart Syndrome seems to be triggered by a strong emotional response to an event but is not fully understood.
What is generally accepted is that Takotsubo is triggered by a high Catecholamine state. Catecholamines are chemicals released by the body during a heightened state of anxiety, most commonly the fight or flight mechanism or after severe emotional stress!!! (REMEMBER BROKEN HEART SYNDROME!)
We understand that Catecholamines change the way in which different parts of the body work, it seems that in some people, a surge of Catecholamines causes one of the following explanations…

Takotsubo Broken Heart Syndrome

Transient Vasospasm. 

The heart has its own blood supply, one theory is that the surge in Catecholamines causes these larger vessels to go into spasm. This spasm will prevent blood reaching all parts of the muscle. This will ‘stun’ the myocardium (a bit like a cramp) and cause it to stop contracting below the point of spasm.

Takotsubo Broken Heart Syndrome

Microvascular Dysfunction.

A theory that follows the same mechanism as the Transient Vasospasm but on the tiny blood vessels of the heart. So in English, the larger vessels like those that can be seen to the image on the right are unaffected but smaller vessels like the ones that can be seen in the image (left) do spasm and cause the heart muscle (Myocardium) to become stunned.

Can it happen to anyone? 
As it stands it does seem to be more common in men and post menopausal women. There is also suggestions that you have to have a certain anatomy to be at risk – these include a ‘wrap around’ Left Anterior Descending Coronary Artery or a slightly thickened outflow tract septum. Apologies that last bit got a bit tecchie.

Diagnosing Takotsubo

NOT EASY! With the symptoms being very similar to a heart attack AND Takotsubo being relatively rare, Diagnosis is not always easy or immediate! Most investigations consider a heart attack as the cause of symptoms and rule that out first!
As if that wasn’t a big enough hinderance the ECG (simple test to see what is happening with someones heart) also imitates that of a heart attack! For all you ECG buffs out there it often looks like an Anterior MI, with ST elevation in V3-V4!
If investigation shows normal coronary arteries (or those with minimal disease) and the OCTOPUS TRAP presentation during an LVGRAM then Takotsubo is queried as a cause of the acute sudden onset heart failure. The classic shape does not always have to be seen but there is normally some form of wall abnormality without obvious cause!

Prognosis

Provided the individual survives the initial acute event (which most do!) Prognosis is good! there are very few associated deaths and in most cases the syndrome completely resolves after a couple of months. During this period treatment is mostly supportive – alleviating complications such as Hypotension (Low Blood Pressure) and fluid build up. Also more surprisingly repeat occurrences of the syndrome are very low in those to have already suffered!

So Can you Die of a Broken Heart?

Surprisingly you can, but of all the things to worry about dying from…. this isn’t going to keep me up at night!
Thank You for Reading
Cardiac Technician
Time to start my Post on Angiograms!

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Image courtesy of Victor Habbick / FreeDigitalPhotos.net
Additional Sources; http://www.actuaries.org.uk/research-and-resources/documents/modelling-short-term-dependence-between-two-remaining-lifetimes

Comments 1

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