A Bad Heartbreak

When was the last time that you felt extremely stressed or emotional? I think we have all been there, but turns out that crying and feeling emotional may not be the only things we will feel. Broken heart syndrome or Takotsubo cardiomyopathy is a condition of the heart that mimics and acute myocardial infarction (MI). Diagnosis is confirmed when cardiac catherization shows that there is no obstruction in the coronary arteries and ballooning of the left ventricle. As you can imagine, this leads to improper functioning of the left ventricle which can lead to acute heart failure. Conventionally, it has been accepted that this is a transient condition as left ventricular dysfunction recovers relatively quickly with normal left ventricular ejection fraction (EF). However, a recent study shows that there may be long-term effects for those who have gone through Takotsubo.

The study tested 74 patients (half with takotsubo history and half without) and had them undergo tests including biomarker analysis, exercise testing, ECG, and cardiac magnetic resonance. The researchers found that those who prior history of takotsubo had significant decrease in oxygen consumption, multiple cardiac deformations, and impaired energetic status. In other words, even after recovery of the left ventricle and its EF, patients still exhibit potential long-lasting phenotype similar to that of heart failure.

I think the most interesting and scary thing that we as future health care workers should be aware of is that this clinically presents itself as an MI but does so through a different pathway. Even though there is normalization of the left ventricle after an episode, the heart may be impaired regardless. This emphasizes to us all as citizens to take care of ourselves mentally and to not be shaken to the core when adversity comes our way as it can have permanent impact on our physical health as demonstrated in the study. Even more so, this study should serve us as a reminder how important it is to actively listen to the patient (i.e. what is their body language, what are they going through, how are they handling it, etc.). Stress management is a skill we ought to teach our patients as it can potentially prevent unusual cardiac pathology such as a literal broken heart.

References:

Scally, C., Rudd, A., Mezincescu, A., Wilson, H., Srivanasan, J., Horgan, G., Broadhurst, P., Newby, D. E., Henning, A., & Dawson, D. K. (2018). Persistent Long-Term Structural, Functional, and Metabolic Changes After Stress-Induced (Takotsubo) Cardiomyopathy. Circulation, 137(10), 1039–1048.