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Don't let the stress of loss destroy you from broken heart syndrome

Clusters of 'broken hearts' may be linked to massive natural disasters as well as fear, personal loss such as divorce, death of a loved one, abuse in relationships, or the taking away of children or a spouse. It extends to the loss of property as well, loss of a career, accidents, or loss of life savings and includes natural disasters. But in a new study, analysis of US Takotsubo cardiomyopathy cases shows pattern to cue emergency responders. You also can check out the abstract of an older 2008 study, "Stress (Takotsubo) cardiomyopathy--a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning, appearing in the the journal National Clinical Practice of Cardiovascular Medicine.

Don't let the stress of loss destroy you from broken heart syndrome.
Anne Hart, photography.

Dramatic spikes in cases of Takotsubo cardiomyopathy, also called broken heart syndrome, were found in two states after major natural disasters, suggesting the stress of disasters as a likely trigger, according to research presented at the American College of Cardiology's 63rd Annual Scientific Session in March 2014. Authors called for greater awareness among emergency department physicians and other first responders.

Takotsubo cardiomyopathy, or broken heart syndrome, is a disorder characterized by a temporary enlargement and weakening of the heart muscle, which is often triggered by extreme physical or emotional stress – for example, being in a car accident or losing a child or spouse

Previous international studies have also linked broken heart syndrome to natural disasters, including the 2004 earthquake in Japan. This is the first U.S. study to examine the geographic distribution of the condition in relation to such catastrophes.

Researchers at the University of Arkansas identified 21,748 patients diagnosed with primary cases of broken heart syndrome in 2011 using a nationwide hospital discharge database. After mapping the cases by state, Vermont and Missouri emerged as having the highest rate of cases, with 380 cases per million residents in Vermont and 169 per million in Missouri. Most states had fewer than 150 cases per million residents. New Hampshire and Hawaii had the lowest rate of the disease that year.

The rate of broken heart cases in Vermont in 2011 was more than double most other states

This was the same year that Tropical Storm Irene pummeled the state with heavy rain and wind, causing the most devastation Vermont has experienced since the Great Flood of 1927. Similarly, researchers found broken heart syndrome at a rate of 169 cases per million in Missouri in 2011, the same year a massive tornado ripped through Joplin, Mo., demolishing neighborhoods and killing at least 158 people.

"Despite the seemingly increasing number of natural disasters we have, there is limited data about how it might affect the heart," said Sadip Pant, M.D., according to a March 27, 2014 news release, "Clusters of 'broken hearts' may be linked to massive natural disasters." Pant is an internist at the University of Arkansas for Medical Sciences, and lead investigator of the study. "Our findings suggest two disasters, one in Vermont and one in Missouri, might have been possible triggers for the clustering of Takotsubo cardiomyopathy cases in these regions."

Patients with broken heart syndrome often complain of chest pain and shortness of breath, symptoms that mimic those of a heart attack, which can delay diagnosis

In addition, biomarkers in the blood and changes on electrocardiogram can raise suspicions of possible heart attack. While broken heart syndrome typically resolves within a month or two, in the acute scenario it can result in serious complications such as heart failure, life-threatening arrhythmias and stroke.

Previous studies by the same group found that as many as one in four patients with broken heart syndrome have some form of arrhythmia and 1 to 7 percent suffer cardiac arrest. Many patients are diagnosed in the cath lab when doctors see there are no blockages in the artery, or imaging reveals changes in the shape of the heart that are characteristic of broken heart syndrome.

Changes in the shape of the heart have a certain characteristic of broken heart syndrome

"By and large, it is a very reversible form of cardiomyopathy, but in the acute phase these patients need to be monitored closely to be sure they are stable and to prevent and manage problems," Pant said, according to the news release, adding that the impetus for the study was the increasing number of cases and a desire to find out what might trigger clusters of broken heart syndrome. "It's also something that emergency doctors and medical personnel need to be aware of as they are often on the frontlines seeing patients after disaster strikes."

Episodes are thought to be driven by the sympathetic response and surges of adrenaline in the body, similar to the well-known fight-or-flight reaction. This leads to depressed function of the apex and middle segment of the heart and increased contractility of the base producing a balloon-like appearance.

The brain connects emotional stress leading to responses in the heart

"It's a perfect example of our brain-heart connection," Pant said, according to the news release. "The emotional stress we have in our brain can lead to responses in the heart, and not much is known about this condition."

Of course everyone's threshold for stress is different. There were other natural disasters in 2011. Pant said that because these events occur more frequently in some parts of the country, residents in these regions may have adapted to and experienced less stress during such occurrences; whereas in places like Vermont, where natural disasters are relatively rare, people may be more susceptible to extreme stress when a disaster hits particularly hard.

Hospital admissions for broken heart syndrome have been on the rise, but it is unknown whether the growing numbers are due to clinicians being more aware of the condition, especially since a reimbursement billing code was established for it in 2006, or if there is a true increase in its incidence. Either way, Pant says it is important to identify potential triggers.

Takotsubo cardiomyopathy got its name because the abnormal shape of the heart resembles a Japanese octopus fishing pot (tako=octopus, tsubo=pot). Pant says more research is needed to further explore the pathophysiological basis and management of this disease.

Physically, men have more adrenaline receptors on their heart cells than women

Men can handle stress better at least when it comes to their heart's mechanisms. Women have a different chemical surge than men when it comes to stress. Then women wonder why do so many women outlive their husbands. Why do more women collapse with broken heart syndrome, but so few men when sudden stress, including both good and bad news is told?

Why are women's hearts so much more hormone-wracked under sudden stress than men's hearts under similar emotional shocks? Check out the November 17, 2011 Associated Press article by Marilynn Marchione, "Women more likely to have 'broken heart syndrome' - Yahoo News."

Women are more likely to have "broken heart syndrome"

What happens is that the balloon shape of the woman's heart that before was normal takes on the shape of a pot. But it takes a big shock. After the shock, what happens in a woman's heart, is that the rush of adrenaline compounds the stress along with more stress hormones from other parts of the body.

The result is that suddenly the woman's heart's pumping chamber balloons out like a pregnant belly and suddenly goes awry. During tests there's a dramatic change in rhythm and blood chemicals that look like a heart attack. But tests show no arteries are blocked. Most of the women take weeks to recover, but then again, you have that one percent of cases that end in fatality. And there also are cases of men dying soon after their wife's crossing over. Yet there are statistics that show more men re-marry after losing their first wife after a marriage that endured time.

During the 1960s, why did 63-year old Sally T. die soon after her 73-year old husband's death from natural causes after 40 years of marriage in which Sally told friends she was very unhappy in the marriage that began in 1926, but financially dependent upon her husband paying all the bills? Did Sally succumb to broken heart syndrome even though the stress of living with her husband's dementia and elder rage was over and she could be relieved of caregiving duties with future dreams of traveling to a warmer climate?

Physicians are now studying broken heart syndrome in women. Check out the news sites, Women More Likely To Have 'Broken Heart Syndrome' and Women More Likely To Have 'Broken Heart Syndrome' - Health. The American Heart Association just finished a conference November 13-16 2011 in Orlando, FL. where the study on broken heart syndrome in women was presented that included studies on the different responses to stress of women compared to men.

What is it about a shock that causes a rush of adrenaline along with numerous other stress hormones to suddenly cause a woman's heart to balloon suddenly and stop working normally?

Tests show dramatic changes in rhythm and blood substances typical of a heart attack, but no artery blockages that typically cause one. Why does a woman's heart break down so drastically and suddenly upon hearing news that surprises, shocks, or informs of either great loss or great gain? Why do some women perish as they walk down the aisle to get married, or find out their husband is cheating, or has lost the family income?

Most victims recover within weeks, but in one percent of the cases the broken heart syndrome proves fatal. Why is a woman's heart so much weaker than a man's when it comes to sudden shock such as loss of a husband or a pleasant shock such as winning a huge amount of money or other prizes, or even meeting a child given away for adoption decades ago?

Women are seven to nine times more likely to suffer broken heart syndrome

According to scientists, women are seven to nine times more likely to suffer "broken heart syndrome," when sudden or prolonged stress like an emotional breakup or death causes overwhelming heart failure or heart attack-like symptoms, the first nationwide study of this finds. Usually patients recover with no lasting damage, but again, in rare cases, about one percent of the female population with broken heart syndrome perish suddenly.

Sometimes widows die within a few days or weeks of losing their husband, even if the husband made them miserable for the past number of decades of their marriage. Why do women respond to stress with a ballooned heart and abnormal rhythms that are so severe?

The issue also focuses on why a woman who has just lost her husband will also suffer heart failure suddenly, whether she was a battered wife, didn't love her husband, or depended upon him totally for financial support and taking care of all the expenses. Heart failure specialists treat many cases of women with broken heart syndrome.

The study focused on women who succumbed as soon as their husbands died or even suddenly fell ill.

Sometimes the women survive, but have to wait weeks until they recover. According to the study and Associated Press article, physicians in Japan studied this syndrome in the early 1990s and called it Takotsubo cardiomyopathy.

Why is it that men don't react that way when males hear shocking news or lose their wives? The first large study of the problem and reported results were presented on November 16, 2011 at the American Heart Association conference in Florida. If you look at case histories four years ago only 671 cases of broken heart syndrome were male. But many more cases involved women. You can check out the statistics in a database of 1,000 hospitals showing 6,229 cases in 2007, according to the Associated Press article. Why so few men suffer this broken heart syndrome compared to women? In fact women were reported to show 7.5 times more incidences of this syndrome than men.

It affects three times more women over the age of 55 than younger women. But when it happens to younger women (under age 55), statistics showed that the younger women were 9.5 times more likely to suffer it than younger men of similar ages. Why are so many more women suffering this type of heart problem than men?

Can it be because women are less likely to find another husband when they are older or saddled with numerous children, compared to men who can more easily find a wife, even through mail order brides? Or is it genetic? Physicians think it's about the hormones that women have not the women's economic fears of the future alone without a husband. Hormones play a role, not fears of who will pay the bills, for most women.

The heart issue cuts through all education and economic levels

Why do some women go into full cardiac arrest and have to have their heart shocked back into a normal rhythm when hearing that their husband is having a heart attack? Why do so many women need to have a defibrillator implanted whereas their husband recover from a heart attack without having a defibrillator implanted in so many instances? Can women build up their resistance to perceive shock and stress less severe? And why do one percent of those cases of women suffering so much more severely than men prove fatal?

The idea that so many women are being scared to death by hearing either bad or good news or loss is frightening to women. And why do 10 percent of the victims get a second episode later, maybe years later? Broken heart syndrome for women usually happens more frequently in summer, whereas heart attacks happen more frequently in winter.

The point is, can psychologists work with women to prepare them for such shocks so they don't die suddenly when they lose their husbands or when a relative suffers a sudden crisis, or even when told they won a contest or other surprise, happy or sad? Check out the study and presentations at the conference from the American Heart Association's website and links.

'Broken heart syndrome' protects the heart from adrenaline overload

A condition that temporarily causes heart failure in people who experience severe stress might actually protect the heart from very high levels of adrenaline, according to a new study, "High levels of circulating epinephrine trigger apical cardiodepression in β2-1 adrenoceptor/Gi-dependent manner: a new model of Takotsubo Cardiomyopathy," published online June 25, 2012 in the journal Circulation. Authors are H. Paur et al.

The research provides the first physiological explanation for Takotsubo cardiomyopathy, also called "broken heart syndrome" because it affects people who suffer severe emotional stress after bereavement, and suggests guidance for treatment.

Around 1-2% of people who are initially suspected of having a heart attack are finally discovered to have this increasingly recognized syndrome

The Imperial College London study, which simulated the condition in an animal model, suggests that the body changes its response to adrenaline by switching from its usual role in stimulating the heart to reducing its pumping power. Although this results in acute heart failure, most patients make a full recovery within days or weeks.

The researchers propose that the switch in the heart's response to adrenaline might have evolved to protect the heart from being overstimulated by the particularly high doses of adrenaline that the body releases during stress.

Patients with Takotsubo cardiomyopathy, most often older women, experience symptoms that resemble a heart attack, but heart tests reveal no blockage in the coronary arteries; instead the heart has a balloon-like appearance caused by the bottom of the heart not contracting properly. The same condition is sometimes seen in people who are injected with adrenaline to treat severe allergic reactions.

In this new research, the authors simulated the condition by injecting high doses of adrenaline in anesthetized rats. In these rats, as in Takotsubo patients, heart muscle contraction was suppressed towards the bottom of the heart. The researchers found that these rats were protected from an otherwise fatal overstimulation of the heart, indicating that adrenaline acts through a different pathway from usual, and that this switch protects the heart from toxic levels of adrenaline.

The study also examined drugs that might be useful for treating Takotsubo cardiomyopathy. Some beta blockers, used to treat high blood pressure, angina and heart failure, reproduced or enhanced the features of Takotsubo, giving new insights into the protective effects of these drugs. Levosimendan, a different type of drug given in heart failure to stimulate the heart without going through the adrenaline receptor pathways, had a beneficial effect.

Adrenaline's stimulatory effect on the heart also can be damaging

"Adrenaline's stimulatory effect on the heart is important for helping us get more oxygen around the body in stressful situations, but it can be damaging if it goes on for too long," said Professor Sian Harding, according to the June 27, 2012 news release, "'Broken heart syndrome' protects the heart from adrenaline overload." Harding is from the National Heart and Lung Institute (NHLI) at Imperial College London, who led the study. "In patients with Takotsubo cardiomyopathy, adrenaline works in a different way and shuts down the heart instead. This seems to protect the heart from being overstimulated."

Study co-author Dr Alexander Lyon, also from the NHLI at Imperial, and consultant cardiologist at Royal Brompton Hospital, set up one of the first specialist services in the UK to look after people who have experienced Takotsubo cardiomyopathy. "Currently it is not fully known how to treat these patients," he said, according to the news release, according to the June 27, 2012 news release, 'Broken heart syndrome' protects the heart from adrenaline overload. "Insights from this work show that the illness may be protecting them from more serious harm. We've identified a drug treatment that might be helpful, but the most important thing is to recognize the condition, and not to make it worse by giving patients with Takotsubo cardiomyopathy more adrenaline or adrenaline-like medications.

"At the Royal Brompton Hospital and Imperial College London we are leading a European initiative to bring together experts to understand this recently recognized cardiac syndrome, and we hope the findings from this work will lead to new treatment strategies for these patients during the acute phase of their illness, and to prevent recurrence".

Funders of the study were the British Heart Foundation (BHF), the Wellcome Trust, the Biotechnology and Biological Sciences Research Council (BBSRC) and the Academy of Medical Sciences.

The syndrome usually is preceded by intense emotional or physical stress

Dr Shannon Amoils, Research Advisor at the BHF, said, according to the news release, "This is a fascinating study which presents a possible explanation for the signs of Takotsubo cardiomyopathy, a rare condition that's usually preceded by intense emotional or physical stress. Patients usually have symptoms that resemble those of a heart attack but nearly all fully recover after a short time.

"The study also provides new insights into how the heart may protect itself from stress, which opens up exciting avenues of exploration for research. We must remember though that this is a study in rats, and the findings need to be confirmed in people before we can be sure of their relevance to patients."

Stress cardiomyopathy, also referred to as Takotsubo cardiomyopathy, is an increasingly recognized clinical syndrome characterized by acute reversible apical ventricular dysfunction, says the older 2008 study.

Researchers hypothesized in that study that stress cardiomyopathy is a form of myocardial stunning, but with different cellular mechanisms to those seen during transient episodes of ischemia secondary to coronary stenoses (narrowing).

In this syndrome, the researchers explained in the study's abstract that they believed that high levels of circulating epinephrine trigger a switch in intracellular signal trafficking in ventricular cardiomyocytes, from G(s) protein to G(i) protein signaling via the beta(2)-adrenoceptor.

Although this switch to beta(2)-adrenoceptor-G(i) protein signaling protects against the proapoptotic effects of intense activation of beta(1)-adrenoceptors, it is also negatively inotropic. This effect is greatest at the apical myocardium, in which the beta-adrenoceptor density is greatest. Back in the 2008 study, the researchers worked with the hypothesis that has implications for the use of drugs or devices in the treatment of patients with stress cardiomyopathy. There are numerous later studies on "broken heart syndrome." What the general public would want to know is how to prevent it and what processes happen when it occurs.

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