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Broken Heart Syndrome

Updated: Nov 19, 2024




The stress experienced by an infinite number of people nowadays is unimaginable. The loss we experience daily is agonizing. However, the struggle we are in today is developing the strength we need for tomorrow. As the COVID-19 pandemic expands, the incidence of broken heart syndrome increases.   Broken heart syndrome (BHS) is a stress-induced weakening of the heart muscles. It is first described in Japan, characterized by a reversible postischemic insult causing a stunning of the heart muscles with a fast and full recovery in most cases. BHS goes by several names including stress cardiomyopathy, Gebrochenes-Herz syndrome, and Takotsubo cardiomyopathy. Takotsubo means an octopus trapping pot with a wide bottom and narrow neck in Japan.  Sudden and extensive stress may cause BHS. The widowhood effect is another name of BHS caused by the grief of a loved one’s death. Good news may even be the cause; A case report of a 70 years old female with hypertrophic heart fainted at a wedding party which was diagnosed later as BHS. Intense fear as public speaking, recurrent nightmare, or even 3-dimensional (3D) entertainment may also be the cause. Extreme anger, severe physical pain, or medical conditions as systemic sclerosis have also been reported. A retrospective study of 1914 participants complaining of acute coronary syndrome with COIVID-19 infection showed that the incidence of stress cardiomyopathy was 7.8% compared to the baseline pre pandemic incidence of 2%. Notably, all the patients in the study tested negative for SARS-CoV-2 by the reverse transcriptase-polymerase chain reaction (RT-PCR) test. The pandemic’s noxious effects on emotional and mental stress are more subjective and cannot be easily quantifiable. However, the older median age group is noticed in COVID-19 patients irrespective of cardiovascular comorbidities and gender. Patients who developed BHS with COVID-19 infection had a higher mortality rate, especially if they were complicated with cardiogenic shock.   BHS mostly affects women (about 88%), especially after menopause (mean age range 58 to 77). As it is the cause of 5% of women complaining from a heart attack. However, the differences are driven by racial disparities in demographics, comorbidities, as well as socioeconomic factors. Several theories have been proposed, including the female hormone estrogen protects against stress. As the level of estrogen declines with age, women might be more susceptible. In Japan, it is more common in men. Recurrent  attacks of BHS have been reported in 5% of patients.   The mortality rate of BHS is extremely low (about 1%). In children, BHS is uncommon, even though it carries a mortality rate of 7%, there is no evidence suggesting that it is hereditary. Most children with BHS are adolescent males with psychiatric disorders or substance use disorders or both.  The exact cause is not fully understood. However, during the stress, your body releases hormones like adrenaline, noradrenaline. Researchers  think that these hormones temporarily interfere with your heart’s function.  Signs and symptoms of BHS include chest pain, shortness of breath, irregular heartbeats, and low blood pressure. In comparison to a panic attack, they do not cause physical damage to the heart muscle. Nonetheless, unlike a heart attack, in BHS your heart muscle is not permanently damaged, and your coronary arteries are not blocked. Complications are rare, but those that have been reported include rupture of the heart wall, heart failure, or cardiogenic shock.   Several tests and imaging to diagnose BHS include mainly electrocardiogram, coronary angiography, echocardiography showing the ace of spades morphology of the ventricle. Several types of Ventricular patterns are noticed. These include the midventricular, and focal wall motion patterns. A case with dextrocardia with situs inversus, another with biventricular affection have been reported. Therefore, it is important to screen the two ventricles for different patterns. Treatment depends on the severity of your symptoms. Medical treatment includes antihypertensive and anti-anxiety drugs. Other approaches as preventive measures include yoga or meditation. Ask your healthcare provider for information on these methods and possible programs and services available. Moreover, generally healthy habits include a healthy diet and regular exercise may help.   The team of a no-kill animal shelter in Washington DC reported that some animals displayed some signs suggesting a BHS condition. These signs included eating rejection with curling in a corner of their cages hiding  their heads in their paws. However, there is no medical evidence that  indicates that pets suffer from the physical symptoms of BHS.  Moreover, people who have chest pain, no matter what the scene, must go to a hospital and have doctors further examine it. After all, Our bodies entail our responsibility. 

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