Broken heart syndromeStress cardiomyopathy (Tako-Tsubo cardiomyopathy, TTC) is a functional disorder of the heart muscle, is also colloquially known as "broken heart syndrome" and in German as "Syndrom des gebrochenen Herzens" (broken heart syndrome). Even if it does not sound like it at first, this is a serious disease that is triggered by severe stress. The clinical picture often occurs in post-menopausal women in connection with intense emotional events. In the majority of patients, a false diagnosis (myocardial infarction) is made, d. h. Broken heart syndrome remains undetected.
What are the symptoms of broken heart syndrome??
Broken heart syndrome has symptoms identical to those of a heart attack, usually occurring immediately after emotional or physical stress. Affected individuals experience chest pain or tightness, palpitations, and shortness of breath. The shape of the left ventricle of the heart is severely altered. The apex of the heart is bulbous or balloon-like dilated and the aorta is severely narrowed, so that no blood can get into the body. After this visual change, Japanese doctors gave this disease its name in the early 90s. The shape reminded them of a traditional clay jar called tako-tsubo, which functioned as an octopus trap.
Normal left ventricle vs. left ventricle with broken heart syndrome
what are the underlying causes of broken heart syndrome?
The exact cause of Broken Heart Syndrome is largely unclear. Possible causes include acute prolonged stress or a tumor (catecholamine-producing tumor). The tumor causes increased hormone release (catecholamine release), which contributes to damage and disruption of the heart muscle cells. In addition, hormonal (sympathetic activation due to estrogen deficiency), viral (cytomegalovirus) and genetic predisposition can also be the cause. Especially in female patients, a significant increase in the stress hormone catecholamine or adrenaline is often observed. The release of the stress hormone occurs after psychological or physical stressful situations such as z.B. A death, a panic attack, a breakup with a partner, an assault, or domestic violence associated with anxiety. Affected people react physically. Mentally more sensitive to stress stimulation than healthy individuals. Thus the saying "something breaks my heart" is quite correct from a medical point of view. Additional factors preceding the onset may include lung disease, brain hemorrhage, stroke, skull injury, surgery, or severe pain.
How to diagnose broken heart syndrome?
Medical findings include sudden left ventricular dysfunction (dysfunction), elevated cardiac enzyme levels (troponin-T) in the blood, normal coronary angiography findings (no changes in the coronary arteries), and a change in the cardiac waveform in the ECG (ST segment elevation, QT prolongation, change in the T wave). However, in contrast to myocardial infarction, no coronary arteries are occluded in broken heart syndrome. This can be ruled out with a cardiac catheterization study. In addition, cardiac enzymes, body fluids, substances, ties, and organs such as the thyroid gland are examined. A sonography of the abdomen and heart, as well as a chest x-ray can also be performed. Anamnesis is crucial. Here, a systematic, in-depth interview is conducted to determine if the onset of symptoms is due to emotional stress.
In 99 percent of cases, the heart fully recovers; only one percent of patients die from complications such as cardiac arrhythmias. It is therefore important that patients receive intensive medical care during the acute treatment phase and remain in the hospital until cardiac function recovers.
What emerged from new research studies?
According to Dr. Christian Moller (University Hospital Schleswig Holstein, Lubeck), cancer patients have an increased risk of broken heart syndrome, i.e. stress cardiomyopathy (TTC). In addition, stress cardiomyopathy is thought to be a risk marker for previously undiagnosed cancer. These new findings were presented at the 82. Annual conference of the German Society of Cardiology (DGK) in Mannheim 2016 presented. The aim of the study was to investigate the incidence of cancer in 286 stress cardiomyopathy patients. The average observation period was four years. Within the study, 18 percent of stress cardiomyopathy patients were found to have underlying cancer. Building on this finding, Dr. Moller a tumor examination, consisting of the X-rays of the chest, ultrasound of the abdominal region, a large blood count and a generally recommended cancer screening 1 .
1 DGK Abstract V 500, Moller et al. Prevalence and Long-term Prognostic Impact of Malignancies in Patients with Takotsubo Cardiomyopathy – Insights from a Large Registry.