In the last several years there has been an increase in the diagnosis of broken heart syndrome. The broken heart syndrome is seen when a patient presents with an acute coronary syndrome or heart attack but has no blocked arteries. Patients will describe a history of chest pain after a sudden emotional stressor. One patient at our institution developed severe pain after seeing her dog get run over. The ECG and blood tests were consistent with a heart attack but the angiogram showed no blockage. The condition is also known as Takotsubo cardiomyopathy and is named after the Japanese octopus traps (tako tsubo) that share a similar appearance to the angiogram of a patient with broken heart syndrome where the lower 2/3 of the pumping chamber contracts poorly and the upper 1/3 contracts vigorously.
Broken heart syndrome is becoming more and more common. It is unclear if the reason is that doctors are simply more efficient at making the diagnosis, or if there is actually an increase in the incidence of the disorder. The disorder is seen more commonly in postmenopausal women. The cause of broken heart syndrome is believed to be related to an excess of catecholamines or adrenalin, which may cause severe spasm of the left anterior descending artery (LAD) or dysfunction of the smaller branches of the LAD. This may cause a temporary decrease or disruption in flow without the characteristic clot seen during a typical heart attack caused by a cholesterol rich plaque rupturing in the artery.
Patients who are affected by broken heart syndrome are treated urgently like all heart attack patients with a heart catheterization, if available. The normal coronary angiogram with abnormal left ventricular angiogram confirms the diagnosis. Medical treatment includes aspirin, beta blockers, angiotensin-converting enzyme inhibitors and statins. In severe cases heart failure may be the predominant symptom. In these cases an intra-aortic balloon pump may be needed as a temporary measure to support the patient. The prognosis of broken heart syndrome is actually quite good. The rate of death is actually lower than for a classic heart attack caused by a clot in the artery. The majority of patients will have complete recovery of heart function in less than 3 months and have no symptoms or side effects. Most patients go on to lead completely normal lives with no significant decrease in life span and a low chance of recurrence.
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