| Subject: One can die of a broken heart |
Author:
Betty
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Date Posted: 09:12:16 02/13/05 Sun
In reply to:
Betty
's message, "no no no, you can have her, she's too fat for me" on 10:16:27 03/10/04 Wed
A patient admitted to a hospital emergency room with all the classic symptoms – chest pain, sweating, fluid in the lungs and shortness of breath – may not be having a heart attack but be suffering from a "broken heart" triggered by anger, fear, grief or shock.
Researchers at Johns Hopkins Medical Center in Baltimore have discovered important new information about "broken heart syndrome" – known to some doctors as stress cardiomyopathy – in which psychological shock can trigger sudden, reversible heart failure that mimics symptoms of myocardial infarction. About two percent of patients with the classic symptoms suffer for several days from a surge in catecholamines (stress hormones such as adrenaline and noradrenaline) that temporarily "stun" the heart.
"Our study should help physicians distinguish between stress cardiomyopathy and heart attacks," said study lead author and Johns Hopkins cardiologist Dr. Ilan Wittstein, "and it should also reassure patients that they have not had permanent heart damage." He and his team published their study in the February 10 online edition of the New England Journal of Medicine (NEJM).
They found that some people may react to sudden, overwhelming emotional stress by releasing large amounts of hormones and their breakdown products into the bloodstream. These chemicals can be temporarily toxic to the heart, effectively stunning the muscle and producing typical heart attack symptoms. But the researchers, who observed 19 cases at Hopkins hospitals over four years (nearly all of them women), determined that stress cardiomyopathy was clinically very different from a typical heart attack.
Doctors who questioned them learned that immediately before the apparent heart attack, they all suffered sudden and severe emotional stress, including news of a death, shock from a surprise party, fear of public speaking, armed robbery, a court appearance or a car accident. Wittstein said one of his earlier patients was given a surprise party for her 60th birthday: Dozens of people jumped out from the dark and screamed "Surprise!" A few hours later, she was in intensive care with a misdiagnosed heart attack, he said.
"These cases were initially difficult to explain because most of the patients were previously healthy and had few heart attack risk factors," Wittstein explained. For example, angiograms showed no diseased coronary arteries or blockages, and blood tests failed to reveal high levels of enzymes released into the bloodstream from damaged heart muscle. The heart function in some victims was so bad they would have died without aggressive treatment to keep their blood circulating, but all – amazingly – recovered, and they did so much faster than heart attack patients, even with only supportive treatment.
Prof. David Hasdai, director of the coronary care unit at the Rabin Medical Center-Beilinson Campus in Petah Tikva – who read the NEJM article online – commented that the syndrome was not new to some cardiologists, as the first cases were identified some years ago in Japan. But doctors had great trouble distinguishing stress cardiomyopathy from heart attacks. The new research, which gave clear criteria for diagnosis, was an advance and would help promote awareness of the problem among physicians.
"We have seen some cases ourselves each year," he said. "They undergo the same diagnostic treatment such as catheterization, and we were always puzzled by the lack signs of a conventional heart attack."
With greater awareness of the syndrome, Hasdai said, such patients would not be given needless treatments such as drugs and other interventions that pose risks to their health. The researchers maintained that while "broken heart syndrome" was not as common as a heart attack, it probably occurred more frequently than it was diagnosed, and that the number of recognized cases would grow as more doctors learned to identify the syndrome's unique clinical signs.
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