Sometimes a Heart Attack Is Really a 'Broken Heart'

Stress can temporarily stun main pumping chamber, study finds

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HealthDay Reporter

WEDNESDAY, Feb. 9, 2005 (HealthDay News) -- It seems the heart can really break, although it can also recover rapidly from the damage wrought by a sudden emotional shock.

The phenomenon is known as "broken heart syndrome," and it can trigger severe, temporary heart muscle weakness that mimics a classic heart attack, Johns Hopkins scientists claim in a new report.

Their study describes 20 patients, almost all of them women, who were hospitalized with all the symptoms of a heart attack, including chest pain, shortness of breath, fluid in the lungs and drastically reduced ability of the heart to pump blood.

But careful study found the problems were just temporary, caused by a massive release of stress hormones called catecholamines that can "stun" the heart. They include adrenaline, and flood the body following emotional shocks ranging from news of a loved one's death, to an armed robbery, to an auto accident, the report said. Rather than requiring the drastic treatment necessary for a heart attack, the patients needed only supportive therapy for a few days to allow the heart to recover, the researchers said.

"This kind of thing has been described by others," said study author Dr. Hunter C. Champion, an assistant professor of medicine at Johns Hopkins School of Medicine. But, he added, it's still important to remind physicians that the cardiac problem might be due to stress cardiomyopathy, rather than a heart attack.

"You can save patients from having treatments such as an implanted defibrillator or even a heart transplant," Champion said.

The study appears in the Feb. 10 issue of the New England Journal of Medicine.

The report described 19 patients, 18 of them women, whose median age was 63 when they came to Hopkins for emergency treatment. "Everyone thought they were having heart attacks," Champion said.

But physical exams and blood tests did not show the symptoms of a heart attack -- no blockage of the coronary arteries, no increased levels of the enzymes released when the heart muscle is damaged, no physical signs of heart damage. However, a striking feature of the syndrome was the heart's unique contraction pattern when viewed by echocardiogram. Although the base of the heart's main pumping chamber, the left ventricle, contracted normally, there was weakened contraction in the middle and upper portions of the muscle.

The patients' condition improved considerably in a few days, and they recovered completely within two weeks, while even partial recovery from a heart attack can take weeks or months, the researchers said.

The Hopkins physicians are doing studies to determine how stress hormones can stun the heart, why the condition strikes predominantly older women and whether there might be a genetic vulnerability to the condition, Champion said.

They also are trying to determine how often it occurs. There have been several reports on stress cardiomyopathy, most from Japan but a few from the United States, Champion said. "But my guess is that it happens much more frequently than has been thought," he added.

"We do see this quite regularly," said Dr. Marc S. Penn, medical director of the coronary intensive care unit at the Cleveland Clinic. "It is not uncommon to see it in patients who have been referred to us."

The Hopkins report "will lead to more questioning of patients before the physician comes up with a diagnosis," Penn said. It also should prompt more measurements to detect elevated levels of the stress hormones described in the new report, he said.

The condition appears to be associated only with "significant life events," Penn said. "We don't think that everyone who has an argument with a spouse goes into heart failure."

More information

Johns Hopkins has more on stress cardiomyopathy.

SOURCES: Hunter C. Champion, M.D., Ph.D, assistant professor, medicine, Johns Hopkins School of Medicine, Baltimore; Marc S. Penn, M.D., medical director, Cleveland Clinic coronary intensive care unit; Feb. 10, 2005, New England Journal of Medicine

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