What is happening to your heart?
“In a heart attack, heart cells die, even if only a small portion. It causes permanent heart muscle damage. After a heart attack, you may still have a sick heart muscle six months later,” says Wittstein.
“By contrast, in broken heart syndrome the cells are only stunned. In the first 24-48 hours after the shock, this stunning can lead to low blood pressure, congestive heart failure, and other problems. The heart muscle looks as weak as those we do heart transplants on. The difference is, the change is only temporary. If you are cared for properly, this muscle wakes up and returns to normal,” he adds.
What causes this stunning? Under sudden stresses, the body releases massive amount of adrenaline and certain other hormones. “That’s great to help you run if you are being chased by a tiger, but otherwise it can be toxic to your heart,” says Wittstein.
Making the right diagnosis
The initial symptoms of stress cardiomyopathy are the same ones bringing most people to the ER for a heart attack; e.g., chest pains, trouble breathing, and nausea. That can make a diagnosis difficult.
“In the ER, an EKG is the major tool for diagnosing heart problems, but stress cardiomyopathy doesn’t show an abnormality in 40% of EKGs. And we still have many doctors and nurses not trained in recognizing this syndrome,” says Sharkey.
Wittstein offers three checkpoints that help his team distinguish if the patient was suffering from stress cardiomyopathy. Among the things he has been urging cardiologists to start looking for: relatively mild elevations levels of the heart protein troponin (which is usually much higher in a true heart attack), arteries showing no blockages upon examination, and rapid recovery of heart muscle function.
What is your stress level?
“Most doctors believe stress has a detrimental effect on the heart, but there wasn’t a lot of good evidence for its actual effect. Studies like Dr. Wittstein’s give primary care doctors even more reason to focus on their patients’ stress levels,” says Elliott Kroger, M.D., Erickson HealthSM medical director of Sedgebrook, a community in Illinois built and managed by Erickson.
“Asking, ‘What’s the stress level in your life?’ often gets the patient to open up. If not I ask specific questions, like whether they are having financial difficulties,” says Sharkey.
But he adds, “Many older patients are very stoic, or they don’t want to admit they have a problem. That is especially true if they have a family member accompanying them.”
Kroger feels the everdecreasing lack of time between primary care doctors and their patients definitely impedes a doctor’s ability to be alert to the person who might likely fall victim to this syndrome. “Without time to develop a rapport, patients may not be willing to discuss stressors in their life. Instead they will make sure they discuss five immediate physical problems and ignore key emotional issues,” he says.
Be alert—and alert your doctor
“It appears that stress cardiomyopathy only affects about 2% of the people who go to the cardiac cath lab to get their heart checked. But if you consider how many people we send to cath labs every day, 2% is still a significant number,” says Wittstein. (In a cath lab, a catheter inserted into the body sends back data on various aspects of the heart’s condition.)
“If you have just had something stressful—whether it is a pleasant surprise or something unhappy like somebody’s death—and you are having chest pain, don’t try and diagnose yourself. People die of this if they’re not treated properly, but can recover completely if it’s caught and treated quickly. So get help right away,” he adds.
And if you are thinking about a surprise birthday party for a 75-year-old female you love…well, maybe you should think again.
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