A New England Journal of Medicine study found that sudden, unexpected and severe emotional distress can actually trigger a weakness of the heart muscle that is akin to a heart attack (myocardial infarction-MI), but is reversal. Shocking news, such as learning of the unexpected death of a loved one, has been known to cause catastrophic events, such as a heart attack.
People can respond to such overwhelming emotional stress, by releasing large amounts of stress related hormones into the circulatory system. This resulting hormone surge, can literally overstimulate the brain and heart, and create symptoms similar to those of a typical myocardial infarction (heart attack), including shortness of breath, chest pain, heart failure, and fluid accumulating in the lungs.
A careful review resulted in the researchers determining that cases of stress cardiomyopathy (heart damage) were in fact very different from those of a typical heart attack. Stress cardiomyopathy is also called “broken heart syndrome.”
The stress hormone levels in those with the broken heart syndrome were 2 to 3 times higher, compared to heart attack patients and 7 to 34 times higher than levels in healthy people.
Other stress hormones were also higher than normal, and biopsies of the heart demonstrated damage consistent with a high catecholamine state and not heart attack.
The lead Johns Hopkins University researcher, Dr. Ilan Wittstein, “Our study should help physicians distinguish between stress cardiomyopathy and heart attacks, and it should also reassure patients that they have not had permanent heart damage.” It is particularly important that doctors make this distinction, since the treatment of stress cardiomyopathy and heart attack are different.
Upon observing several cases of “broken heart syndrome” at Hopkins hospitals, and noting they were primarily middle-aged or elderly women, the researchers became aware that these patients had very different typical cases of heart attack, and that something very different was happening. These cases were, initially, difficult to explain because most of the patients were previously healthy and had few risk factors for heart disease.”
The recovery rates were much faster than typically seen after a heart attack. Stressed patients experienced dramatic improvement in their hearts’ ability to function and pump blood a few days after the episode and complete recovery within two weeks. In contrast, partial recovery after a heart attack can take weeks or months and, frequently, the heart muscle damage is permanent.
The researchers accumulated detail information regarding the medical histories of the patients, and conducted several tests, including blood work, echocardiograms, electrocardiograms, coronary angiograms, MRI scans and heart biopsies, on a total of 19 people who were admitted to Hopkins between November 1999 and September 2003.
All of them experienced symptoms of an apparent heart attack immediately after some kind of sudden emotional stress, including news of a death, shock from a surprise party, fear of public speaking, armed robbery, a court appearance and a car accident.
The “broken heart” syndrome has been around for centuries. Reports exist, primarily from Japan, and describe similar syndromes. No biochemical analyses have previously been performed that link the condition to elevated catecholamine levels. The researchers contend that while stress cardiomyopathy is not as common as a typical heart attack, it likely occurs more frequently than doctors realize. They expect its numbers to increase as more physicians learn to recognize the syndrome’s unique clinical features.