Shital Kiran Bhalerao
ITM-IHS College of Nursing, Panvel, Navi Mumbai, Maharashtra-410206.
*Corresponding Author E-mail: shitalb@itm.edu
ABSTRACT:
Broken heart syndrome is a medical illness that is characterised by temporary left ventricular failure without severe coronary artery disease. It is sometimes referred to as stress-induced cardiomyopathy or takotsubo cardiomyopathy. Acute myocardial infarction-like symptoms are usually mimicked when it manifests itself in reaction to emotional or physical pressures. A myocardial shocking surge caused mainly by an increase in catecholamines largely affects the apical portions of the left ventricle in the pathophysiology of broken heart syndrome. The clinical presentation, electrocardiographic alterations, cardiac biomarkers, and imaging tests like echocardiography are frequently combined to make the diagnosis. Most patients recover ventricular function within weeks to months, and the prognosis is generally favourable. On the other hand, issues like ventricular rupture and, in rare instances, cardiac failure and arrhythmias can happen. Beta-blockers are advised to prevent recurrence, and supportive care and treating underlying stressors are the main goals of management. The present understanding of broken heart syndrome is examined in this review, with a focus on its clinical importance, difficulties in diagnosis, and management approaches.
KEYWORDS: Broken Heart Syndrome, Left Ventricular Failure, Coronary Artery Disease, Stress-Induced Cardiomyopathy, Takotsubo Cardiomyopathy, Mimicked, Myocardial Shocking Surge, Myocardial Infarction, Catecholamines, Cardiac Biomarkers, Echocardiography, Ventricular Rupture, Cardiac Failure, Arrhythmias, Beta-Blockers, Stressor.
INTRODUCTION:
Acute mental or physical stress can cause Broken Heart Syndrome (BHS), sometimes referred to as Takotsubo cardiomyopathy or stress-induced cardiomyopathy. BHS is a transient and frequently curable cardiac illness. The condition was initially reported in 1990 in Japan by Dr. Hikaru Sato, who observed that the patients' heart ventricles developed an odd shape that resembled a Japanese "takotsubo," or octopus’s pot.1.
It's a rare kind of illness that shows up as momentary failure of the left ventricle, frequently brought on by sudden physical or emotional stress.2 The disease was first identified in Japan in the 1990s, and its name comes from the way the left ventricle balloons during systole, giving it the appearance of a traditional Japanese octopus’s trap, or "takotsubo."3
Broken heart syndrome happens without a severe coronary artery blockage, unlike a typical myocardial infarction brought on by obstructive coronary artery disease. Rather, it is believed to be caused by an increase in stress hormones, specifically catecholamines like adrenaline, which momentarily paralyse the heart muscle, particularly the left ventricle's apex. This amazing result can cause symptoms that resemble a heart attack, including chest pain, shortness of breath, and even abrupt heart failure.4
Because the clinical presentation of broken heart syndrome resembles that of myocardial infarction, diagnosing it can be difficult. A combination of clinical suspicion, electrocardiographic abnormalities (like T-wave inversion or ST-segment elevation), high cardiac biomarkers (like troponin), and distinctive results on imaging tests (like echocardiography or cardiac MRI) is usually needed.5
Broken heart syndrome frequently has a good prognosis, with most patients regaining complete ventricular function in a matter of weeks to months, despite its abrupt appearance. On the other hand, consequences like ventricular rupture, arrhythmias, and heart failure highlight how crucial a precise diagnosis and suitable treatment are.6
This introduction sets the stage for a deeper exploration of broken heart syndrome, highlighting its unique pathophysiology, clinical features, diagnostic challenges, and management strategies aimed at optimizing patient outcomes.
DEFINITION:
Broken Heart Syndrome (Takotsubo Cardiomyopathy): A temporary heart condition triggered by severe emotional or physical stress, leading to sudden, reversible heart muscle weakness and symptoms similar to a heart attack.7
Background:
Broken heart syndrome, also called takotsubo cardiomyopathy or stress-induced cardiomyopathy, is a medical disorder in which severe physical or emotional stress results in an abrupt heart attack. Dr. Keiichiro Sato and associates initially described it in Japan in 1990. They called it "takotsubo" because the disease-affected left ventricle of the heart resembled a particular kind of Japanese octopus’s trap.8
Historically, until the early 1990s, the illness wasn't generally known or understood. Before then, it was common to misdiagnose or assign alternative reasons to cases of abrupt heart failure linked to intense emotional stress. The condition can be brought on by a range of emotional stressors, including the death of a loved one, a major accident, or even a happy event like winning the lottery, in addition to physical stressors like illness or surgery, as study has demonstrated over time.9
Over the past few decades, there has been a tremendous increase in the identification and understanding of the illness. Since it includes a transient disturbance of cardiac function rather than a blockage in the coronary arteries, medical practitioners now recognise that it differs from a heart attack (myocardial infarction). The main goals of treatment are often to control symptoms and deal with underlying stressors.10
While the term "broken heart syndrome" was coined in Japan in the 1990s by Hikaru Sato, the idea that emotional stress has an adverse effect on the heart has long been recognised. Its mechanism was only formally recognised and understood later on, especially following a seminal study conducted in 2005.11
So, while broken heart syndrome is a relatively recent medical discovery, the phenomenon of emotional distress affecting physical health has been observed throughout history, even if the exact mechanisms and diagnosis were not understood until more recently.12
Crucial Features of Broken Heart Syndrome:
1) Psychological vs Physical Triggers:
The following things can cause Broken Heart Syndrome (BHS):
· Stressors in Emotion: Like a loved one passing away, getting divorced, or going through big changes in life. Stress hormones that impact the heart may suddenly spike as a result of these emotional shocks.
· Physical stressors: Include life-threatening illnesses, significant surgeries, and serious physical damage. For instance, the syndrome may also be brought on by severe medical disorders or a traumatic physical incident.13
Both types of stress can cause the heart to temporarily weaken and function abnormally, leading to BHS.
2) Cardiac and Non-Cardiac Issues:
Although the majority of Broken Heart Syndrome (BHS) survivors heal without any long-term
problems, some may encounter:
· Heart Failure: A transient decrease in the heart's capacity to pump blood.
· Arrhythmias: Unusual cardiac rhythms that could appear while the condition is present.
· Blood Clots: In rare cases, decreased blood flow can result in the formation of clots.
A serious and perhaps fatal illness known as cardiogenic shock occurs when the heart is unable to pump
enough blood.3
These complications are uncommon but highlight the need for careful monitoring and management during recovery.
3) Recurrence and Prospective:
Recurrence is possible, even though most people recover in a few weeks. A second episode of BHS affects about 10-15% of patients and is usually brought on by another severe mental or physical stressor. Many patients recover totally, and the long-term prognosis is generally good. However, some patients may experience minor heart malfunction or persistent cardiac symptoms like tiredness. Text 14
4) Differences In Gender:
Women are the primary victims of Broken Heart Syndrome (BHS), particularly those who have gone through menopause. It is believed that this is caused by lower oestrogen levels, which may lessen estrogen's heart-protective benefits. Though it's less common and frequently linked to physical stressors rather than emotional ones, BHS can also affect men.15
5) The autonomic nervous system's function:
The body's reaction to stress is governed by the autonomic nerve system. A spike in stress hormones (adrenaline) from the sympathetic nervous system can "stun" the heart in Broken Heart Syndrome (BHS), causing transient malfunction. The irregular activity of the heart may be caused by the parasympathetic nervous system's inability to completely offset this stress reaction, which normally calms the body.1
6) Impact on Mental and Psychological Health:
· Anxiety about the syndrome's possible return is one of the major psychological repercussions of
· experiencing Broken Heart Syndrome (BHS).
· Post-traumatic stress disorder brought on by the startling and terrifying event.
· Depression brought on by health issues and stress.16
It is critical to address these mental health issues in order to promote general healing and wellbeing.
The following factors may contribute to Broken Heart Syndrome (BHS):
· Catecholamine Surge: An abrupt rise in stress chemicals such as adrenaline that causes the heart muscle to momentarily weaken.
· Coronary Artery Spasm: Stress can lead to a brief constriction of the heart's arteries, which lowers blood flow.
· Microvascular Dysfunction: Reduced blood flow and weakening of the heart muscle may result from impaired function of the small blood arteries in the heart.17
These pathways contribute to the understanding of how high levels of stress impact BHS heart function.
8) Distinguishing Broken Heart Syndrome (BHS) from a Heart Attack:
Although both conditions exhibit comparable symptoms, there are some important distinctions between the two:
· Blockages in the Coronary Arteries: BHS usually does not include the clogged arteries that cause heart attacks.
· Damage to Heart Muscle: BHS results in transient heart muscle dysfunction that typically resolves completely, whereas heart attacks inflict lasting damage.
· Location of Dysfunction: Heart attacks can affect different areas of the heart muscle, whereas BHS typically affects the apex, or tip, of the heart particularly.14
9) Distinctive Diagnosis:
In order to distinguish Broken Heart Syndrome (BHS) from other illnesses:
· Myocardial Infarction, or Heart Attack: BHS resembles heart attacks, but typically has no coronary artery disease.
· Myocarditis: An infection-related inflammation of the heart muscle that manifests differently from BHS.
· Pulmonary Embolism: Diagnostic studies such as CT scans are necessary to rule out blood clots in the lungs that cause similar symptoms.18
An accurate diagnosis guarantees the right course of action and supervision.
10) Controlling and Preventing Stress:
The secret to avoiding Broken Heart Syndrome recurrences is stress management (BHS). Methods
consist of:
· Individuals can better manage stress and emotional triggers with the aid of cognitive behavioural therapy (CBT).
· Methods of Relaxation: Stress reduction techniques include yoga, deep breathing, and meditation.
· Exercise: Heart strength and stress resilience are enhanced by regular physical activity.
· Medication: To help control stress and safeguard the heart, doctors may recommend beta-blockers or other drugs.19
These methods lower the chance of recurrent attacks while preserving cardiac health.
In conclusion, emotional and physical stress are directly linked to broken heart syndrome, which is a complicated disorder. Most people who receive the right diagnosis and treatment recover completely, but maintaining heart health and preventing recurrence require long-term stress and emotional health management.
OVERVIEW OF BROKEN HEART SYNDROME
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Received on 20.09.2024 Revised on 28.11.2024 Accepted on 13.01.2025 Published on 28.02.2025 Available online from March 26, 2025 A and V Pub Int. J. of Nursing and Med. Res. 2025; 4(1):58-61. DOI: 10.52711/ijnmr.2025.12 ©A and V Publications All right reserved
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