The causes of "broken heart syndrome" remain a mystery, but doctors will soon have an easier time recognizing and treating this rare, life-threatening condition, thanks to data reported at the 30th Annual Scientific Sessions of the Society for Cardiovascular Angiography and Interventions.
Researchers from Brown University in Providence, RI, have developed the largest registry of patients in the United States with Takotsubo cardiomyopathy, informally known as broken heart syndrome because it is often preceded by an emotional or physical shock of some kind and almost always strikes women. One thing is certain: Patients are usually critically ill during the first 48 hours.
"These patients can be difficult to manage for emergency physicians and cardiologists alike," said cardiology fellow Richard Regnante, M.D. "They may be in cardiac arrest, cardiogenic shock, or severe heart failure. They may require advanced life support with airway management and medications to support blood pressure."
In fact, based on symptoms, electrocardiographic (ECG) tracings, and blood tests for heart damage, it often seems as if the patient is having a heart attack. The mystery deepens in the cardiac catheterization laboratory, when the interventional cardiologist finds no blockage in the coronary arteries.
To date, the registry has enrolled 40 patients diagnosed with Takotsubo cardiomyopathy at two major hospitals in Rhode Island over a period of nearly 2 years. Ninety-five percent were women, and 60 percent experienced some type of stress shortly before coming to the emergency room. The intensity of the stress varied dramatically, however, ranging from armed robbery to a heated argument, tooth extraction, or preparation for a colonoscopy.
"We don't know why some women develop this syndrome after what appears to be minimal stress, while other women experience severely stressful events but don't develop Takotsubo cardiomyopathy," Dr. Regnante said. A surge of stress hormones likely plays a role, he said, but it is also possible that a blood clot temporarily blocks a major artery of the heart, then dissolves before being detected during coronary angiography.