Broken Heart Syndrome

Special thanks to the Gold Coast University Hospital and Dr.Rahman for allowing me to do this story and photo-shoot

The heart is a muscular organ about the size of a fist, located just behind and slightly left of the breastbone. Weighing around 280 to 340 grams in men and 230 to 280 grams in women.

The coronary arteries run along the surface of the heart and provide oxygen-rich blood to the heart muscle. A web of nerve tissue also runs through the heart, conducting the complex signals that govern contraction and relaxation. The heart pumps around 5.7lts of blood though our body every minute and beats around 100,000 times a day and about 35 million times in a year. During an average lifetime, the human heart will beat more than 2.5 billion times.

If you were to lay out all of the arteries, capillaries and veins in one adult, end-to-end, they would stretch about 100,000 km. That means a person's blood vessels could wrap around the planet approximately 2.5 times!

According to the ABS National Health Survey

• Each year around 56,000 Australians suffer a heart attack.

• heart attack every 9 minutes.

• More than 340,000 Australians have had a heart attack at some time in their lives

• Each year, almost 9,300 Australians die of heart attack.

• That is one Australian life claimed every 57 minutes.

• One in four people who die from a heart attack die within the first hour of their first symptom

When you hear people say they died of a broken heart, they were suffering from a broken heart, it is assumed to be a metaphor for an emotional state of mind rather than a real physical condition.

This connection that our physical body has with our emotional state of being that when our physical and / or emotional health exceeds the amount of stress we are capable of processing it triggers a release of hormones that affect the left ventricular chamber of the heart which cause similar physical symptoms of a heart attack.

the heart has the capacity to store emotional and behavioral memory leaving the possibility that the heart communicates to the brain to release the hormones that affect the heart. [Institute Heart Math]

Above is a xray of a heart belonging to a middle aged man in his early fifties diagnosed with Broken Heart Syndrome, which was found after he complained about having chest pain. During his angiogram it was found he had Takostubo Cardiomyopathy.

So what is it and how does it occur; A leading Cardiologist Dr. Rahman from the Gold Coast University explains it like this;

The heart loses its contractual functions or its squeezing capacity it loses its ability to function as a pump and the mid-segment and apex becomes very high pool contractual meaning it becomes like a balloon and it doesn’t contract in the way it should contract. It is often triggered by massive emotional stress like a death in the family, car accident, argument, family break up, divorce. Post-menopausal women are more susceptible to Broken Heart Syndrome than non-menopausal or younger women or males. The reason for that is that estrogen has an important role to play this is because after menopause the level of oestrogen falls and down regulates the adrenergic receptors of the apex of the left ventricle in the heart. Adrenergic receptors are the stress hormone receptors so when there is a surge of stress hormones following an emotional stress the adrenergic receptors pick up those stress hormones and causes an intense spasm of the coronary artery. This means the heart muscle itself does not get enough blood supply transiently so it becomes stunned and very dilated and non functioning like a balloon. Estrogen gives more immunity and low levels of estrogen make the heart more susceptible to Broken Heart Syndrome. The focus is usually placed on post-menopausal women but men are not immune to Broken Heart syndrome. Not much was known about this syndrome until 1990 and it was considered a rare condition but the more study done about this syndrome the more Doctors realize it is more common than first thought. About 2% of all cases admitted to the Gold Coast Hospital with Cardiovascular Disease show diagnoses of Broken Heart Syndrome. Although it is mostly thought that the trigger is intense emotional stress, it could be triggered by stress caused by fear or anger.

Friday 2010 Joyce’s husband went out fishing in his boat on the river this was one of his favourite past times. He seemed healthy and didn’t look or feel sick at all, Joyce saw him off in the morning and went about her business. That afternoon she received the news that her husband died on his boat from a massif heart Attack, it was only a few hours later that the emotional weight of her loss caused her to have the same symptoms of a heart attack it was the continual insistence of her friend that she go to the hospital. The hospital she was first admitted to transferred her to the Gold Coast Hospital where she was diagnosed with Takotsubo Cardiomyopathy.

It is alleged that Broken Heart Syndrome is caused by overwhelming emotional stress placed on the mind and body. “Takotsubo Cardiomyopathy mimics acute coronary syndrome in presentation and is seen most commonly in post-menopausal women following intense emotional or physical stress.” [Rahman Atifur, David Liu. Australian Family Physician 41 (2012) 55-58].

The only way to be sure if it is a heart attack or Broken Heart Syndrome is to have an Angiogram.

References / Bibliography

1 :Yoshihiro J. Akashi, David S. Goldstein, Giuseppe Barbaro and Takashi Ueyama. “Takotsubo Cardiomyopathy A new form of Acute, Reversible Heart Failure.” Circulation 118 (2008): 2754-2762 Doi: 10.1161/CIRCULATIONAHA.108.767012

2: Krpata M. David, Edward M. Barksdale Jr. “Trauma Induced Ventricular Apical Ballooning Syndrome in a 15year old: a rare case of Takotsubo Cardiomyopathy” Journal of Pediatric Surgery 48 (2013) 876-879

3: Rahman Atifur, David Liu. “Broken Heart Syndrome a case study.” Australian Family Physician 41 (2012) 55-58

4: Glamore Michael, Carlos Wolf, Joseph Boolbol and Michael Kelly. “Broken Heart Syndrome: A Risk of Teenage Rhinoplasty.” Aesthetic Surgery Journal 32 (2012): 58-60

dio: 10.1177/1090820X11430500

5: Butterly J. Stuart et al (“and others”) “Stress induced Takotsubo Cardiomyopathy in Survivors of the 2011 Queensland Floods.” MJA (2013): 109-110 doi: 10.5694/mja12.11620

6: Wittstein S. Ilan et al (“and others”) “Neurohumoral Features of Myocardial Stunning Due to Sudden Emotional Stress” The New England Journal of Medicine 352. (2005): 539-548

7: Kevin A. Bybee, MD; Tomas Kara, MD et al (and others)

“Transient Left Ventricular Apical Ballooning: A Syndrome That Mimics ST-Segment Elevation Myocardial Infarction” 7 December 2004 Annals of Internal Medicine Volume 141 Number 11 Ann Intern Med. 2004;141:858-865.9:

8: Salim S. Virani MD, A.NasserKhan MD et al (and others) “Takotsubo Cardiomyopathy, or Broken-Heart Syndrome” Texas Heart Institute Journal Volume 34, Number 1, 2007