Broken heart syndrome

Broken heart syndrome is not just another metaphor about a love story gone wrong. It is a real diagnosis, which in medicine is also called stress cardiomyopathy or Takotsubo cardiomyopathy. This disease is considered rare and therefore has not been studied enough. Although many experts are inclined to believe that the syndrome is much more common than it is diagnosed: its symptoms are often mistaken for signs of other cardiovascular pathologies.

Epidemiology

Broken heart syndrome develops mostly in female patients, and mainly after 60-70 years. According to statistics, the majority of patients are women from 62 to 76 years old.

The most common time for the disease to appear is the winter season, which is also characterized by the development of seasonal depression.

In approximately 4-6% of cases, the syndrome develops again, and 70% of cases are associated with a stressful situation such as the sudden loss (death) of a loved one.

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Causes of broken heart syndrome

At the moment, the exact cause of the broken heart syndrome has not been determined. Such versions as psycho-emotional stress, emotional overstrain (mainly of a negative nature), which lead to an increase in the level of catecholamines in the bloodstream (especially important in this case is the excess of adrenaline content), are being considered.

The disruption of the heart's work as a result of the release of stress substances into the blood provokes further development of malfunctions and damage to the heart muscle. Also, in this process, an important role is played by the simultaneous short-term narrowing of the arterial vessels of the heart.

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Risk factors

The main risk factors that can lead to the development of broken heart syndrome can be identified:

• sudden loss of a loved one or someone close to you;
• manifestations of violence within the family, bullying and moral pressure in the work collective;
• sudden financial collapse resulting from the loss of a significant amount of money (possibly as a result of fraudulent activity);
• disaster, accident, terrorist act;
• the emergence of unbearable physical or intellectual stress with an inflated sense of responsibility;
• severe infectious, pulmonary, oncological diseases;
• severe surgical interventions.

Conditions such as narrowing or spasm of the coronary arteries, atherosclerotic changes in the arterial vessels of the heart, as well as any diseases that lead to deterioration of the blood supply to the myocardium contribute to the development of the syndrome.

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Pathogenesis

According to the most recent ideas, the fundamental factor in the development of broken heart syndrome is considered to be a sharp psycho-emotional or even physical overload. Acute release of catecholamines into the blood and hypersensitivity of adrenoreceptors, nerve conduction disorder in the apex of the heart, somatic failure in the hypothalamus nuclei represent the body's reaction to the stress received.

The role of sudden physical overload and even sudden and severe hypothermia in the mechanism of development of the syndrome cannot be ruled out.

The mechanism of the origin and development of broken heart syndrome has not yet been fully substantiated. A number of theories are currently under discussion, according to which in most cases there is a spastic contraction of the coronary arteries in the epicardium section of the coronary blood flow. At the same time, microcirculation is disrupted. However, such theories have no empirical confirmation, so the pathogenesis of the disease is still under study.

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Symptoms of broken heart syndrome

The clinical picture of broken heart syndrome often resembles the signs of myocardial infarction, since the main symptoms are:

• attacks of pain localized behind the sternum;
• difficulty breathing, shortness of breath (both at rest and after physical exertion);
• sometimes – decreased blood pressure;
• sometimes – heart rhythm disturbances;
• a feeling of sudden general weakness.

The first signs of the syndrome, including pain, usually last about 25 minutes and are not eliminated by taking nitroglycerin. It should be noted that in case of myocardial infarction, the symptoms remain pronounced for a much longer time. In cases where the pain is severe and radiates under the shoulder blade, into the shoulder joint, forearm, neck or jaw, then seeking emergency medical care should be urgent and mandatory.

Stages

Broken heart syndrome is usually divided into several stages. Since the onset of pathology may not manifest itself with any signs, the initial stage can be characterized as the initial stage of incipient vegetative disorders.

The second stage is the actual attack of the syndrome, which can occur in two periods: the compensatory period, when changes in the cardiovascular system are reversible, and the period of decompensation (the period of persistent negative dynamics).

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Forms

In addition, certain types of heart damage are distinguished. Such varieties determine the localization of disorders in the heart muscle:

• diffuse lesion;
• focal lesion.

The proposed classification helps to clarify the diagnosis, which is especially important when broken heart syndrome develops repeatedly, or other pathologies of the heart and blood vessels appear against its background.

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Complications and consequences

The development of broken heart syndrome can result in the emergence of all sorts of complications, including those that can pose a danger to the patient’s life.

The most dangerous complications of broken heart syndrome may include:

• cardiac insufficiency, which is accompanied by a gradual decrease in cardiac output and a lack of oxygen in the tissues;
• acute infarction – development of necrosis in an area of the myocardium due to oxygen starvation;
• Heart rhythm disturbances are a consequence of tissue structure disruption, when bioelectric impulses lose the ability to qualitatively “disperse” throughout the heart muscle;
• thromboembolism can occur when there is a disruption in interchamber blood flow, which increases the activity of the blood coagulation system;
• pulmonary edema - occurs as a result of blood stagnation in the vascular bed of the pulmonary circulation.

In addition, it is possible that with the next shock, broken heart syndrome may reoccur.

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Diagnostics of broken heart syndrome

If broken heart syndrome is suspected, the doctor may use the following types of diagnostics:

• A survey and general examination of the patient is carried out in order to clarify whether the patient has had heart problems before, after what incident or case the first symptoms appeared, etc. As a rule, most patients insist that they have not previously complained about their heart function.
• Blood tests may indicate elevated levels of certain enzymes that are out of proportion to the amount of heart muscle affected:
  • troponin I – 85%;
  • MB fractions of creatine phosphokinase – 73.9%.
• Instrumental diagnostics may include:
  • electrocardiography – a non-invasive test that uses electrodes placed on the patient’s body to record cardiac activity;
  • chest echocardiography is a common diagnostic method that allows determining the effect of ballooning in the apex area with blockage of the outlet of the left ventricle, as well as the immobility of the anterior wall of the interventricular membrane;
  • ventriculography and MRI - help to detect immobility of certain sections of the left ventricle against the background of increased contractile activity in the basal sections. Impaired right ventricular function is manifested by low mobility or immobility mainly in the apicolateral region;
  • Coronary angiography may indicate the presence of coronary arterial stenosis.

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Differential diagnosis

Differential diagnosis of broken heart syndrome is a rather complicated process. The problem is that the symptoms of cardiovascular damage have much in common with both myocardial infarction and other types of cardiomyopathy. Sometimes it is difficult for a doctor to determine even the primary or secondary nature of the disease.

The complexity of diagnostics often determines the tactics of conducting research, because only with all the maximum possible information can one make the correct diagnosis with the utmost accuracy and carry out the correct treatment measures.

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Treatment of broken heart syndrome

An optimal and unified treatment regimen for broken heart syndrome is still under development. As a rule, the patient is prescribed medications that support cardiac activity and prevent spasm of arterial vessels. It is possible to use:

• ACE inhibitors (captopril, ramipril, fosinopril);
• β-blockers (carvedilol, labetalol);
• blood thinners (aspecard, cardiomagnyl, warfarin, phenylin, aspirin);
• diuretics (ethacrynic acid, indapamide, spironolactone);
• calcium antagonists (verapamil, amlodipine, nifedipine).

	Method of administration and dosage	Side effects	Special instructions
Ramipril	Take orally 1.25-2.5 mg up to 2 times a day.	Low blood pressure, headache, weakness, bowel disorders, cough.	The drug is not used to treat patients under 18 years of age.

	Method of administration and dosage	Side effects	Special instructions
Carvedilol	The dosage is selected individually and can range from 12.5 to 25 mg twice a day after meals.	Allergy, headache, dizziness, sleep disorders, peripheral circulatory disorders, shortness of breath, abdominal pain, thirst, dyspepsia.	Taking high doses of the drug can cause a sharp drop in blood pressure, which requires emergency measures.

	Method of administration and dosage	Side effects	Special instructions
Cardiomagnyl	Take 2 to 6 tablets per day, depending on the patient’s condition.	Increased risk of bleeding, anemia, sleep disorders, digestive disorders, allergies.	The drug should not be taken simultaneously with antacids and NSAIDs.

	Method of administration and dosage	Side effects	Special instructions
Indapamide	Take 1 tablet orally in the morning with water.	Fatigue, headache, low blood pressure, thirst, cough, dyspepsia.	The drug is not prescribed for strokes, or for children under 18 years of age.

	Method of administration and dosage	Side effects	Special instructions
Nifedipine	Take 0.01-0.03 g up to 4 times a day for 4 to 8 weeks.	Redness of the face, headaches, low blood pressure.	The drug is not prescribed for severely low blood pressure.

In addition to medications, it is necessary to take certain vitamins to strengthen the heart and blood vessels. They are necessary to prevent further development and recurrence of the syndrome, as well as to speed up the restoration of cardiac tissue.

Which vitamins will provide the most benefit for broken heart syndrome?

• Ascorbic acid – will strengthen the heart and prevent high cholesterol levels in the blood.
• Vitamin A – improves metabolic processes in tissues and prevents atherosclerotic changes in blood vessels.
• Vitamin E – will support heart function and help damaged tissue recover.
• Vitamin P – will strengthen the vascular walls and facilitate blood circulation.
• Vitamin F – prevents the formation of atherosclerotic plaques in blood vessels.
• Vitamin B1 – stimulates heart contractions.
• Vitamin B6 – will remove excess cholesterol.
• Vitamin-like substance Q10 will improve the nutrition of the heart muscle and prevent myocardial aging.

The doctor will tell you whether to take the proposed vitamins in the form of mono or poly preparations. In mild cases, you can get enough vitamins simply by adhering to certain nutritional principles, because a person receives a large number of useful substances from food products.

Physiotherapy treatment

Physiotherapy for broken heart syndrome is usually aimed at restoring normal cardiac function, improving coronary circulation and cardiac muscle contractility, sensitivity and automaticity.

The use of physiotherapy for broken heart syndrome has not been sufficiently studied, therefore this method of treatment is not recommended for severe extrasystole, paroxysmal tachycardia, unstable angina, or cardiac asthma.

The following physiotherapy procedures are often prescribed for the syndrome:

• electrosleep – an electrotherapeutic method using low-frequency pulsed currents;
• galvanotherapy is a medical procedure using continuous direct electric current;
• medicinal electrophoresis is a painless physiotherapeutic procedure that involves “delivering” medication directly to the tissues, bypassing the digestive tract and circulatory system;
• Ultra-high frequency therapy is a gentle effect of high-frequency electromagnetic fields on a specific area or organ of the patient;
• magnetic therapy – treatment using magnetic fields;
• Ultra-high frequency therapy is a microwave therapy based on the use of electromagnetic radiation with a frequency of 300 MHz – 30 kHz.

Hydrotherapy is used in the form of contrast water procedures, underwater massage, and showers. Such procedures stabilize the work of the autonomic nervous system, reduce the myocardium's need for oxygen, normalize metabolism in heart tissue, expand the body's internal reserves, and improve vascular reactivity.

Folk remedies

Traditional healers claim that broken heart syndrome can be successfully treated with folk remedies, and some of these recipes are recommended for use as a preventative measure.

1. Viburnum berries (fresh or dried) should be consumed orally every day, approximately 100 g, washed down with clean water.
2. Pour 1 tbsp of flaxseed into 1 liter of boiling water and leave for an hour. Take the infusion in equal doses throughout the day (approximately 100 ml every 1-1.5 hours).
3. Prepare a mixture of 100 ml of kefir and 200 ml of carrot juice, add 3 tbsp. of honey and 3 tsp. of lemon juice. Divide the mixture into three doses and take them 30 minutes before breakfast, lunch and dinner.
4. Pour 1 teaspoon of chicory rhizome with 200 ml of boiling water, leave for half an hour under the lid. Take the infusion ¼ cup up to 4 times a day, daily.

You can supplement the proposed treatment with herbal medicines.

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Herbal treatment

For broken heart syndrome, the use of the following herbal mixtures is indicated:

• Mix 10 g of mint leaves, 5 g of valerian rhizome, 10 g of marsh cinquefoil leaves and 5 g of hop cones. Pour 250 ml of boiling water over the mixture and leave for 40 minutes. Take the remedy throughout the day in small portions. Duration of treatment is up to 3 weeks.
• Prepare a mixture of 15 g of mint, 20 g of valerian rhizome, 5 g of lily-of-the-valley flowers, 10 g of fennel. Pour 250 ml of boiling water over the mixture and leave for 40-50 minutes. Take ¼ cup twice a day for a month.
• Mix 20 g of buckthorn bark, 20 g of chamomile flowers. Infuse 1 tbsp of the mixture in 250 ml of boiling water. Take 200-250 ml before bedtime.
• Mix equal parts of chamomile flowers, mint leaves, fennel seeds, valerian root, caraway seeds. Brew 1 tbsp of the mixture in 250 ml of boiling water, take at night.

Homeopathy

The use of homeopathic preparations will help eliminate painful sensations during an attack of broken heart syndrome, improve cardiac circulation, strengthen the myocardium and vascular walls.

Homeopathic remedies are virtually devoid of side effects and contraindications, so they can be taken by both children and adults. But it should be remembered that such drugs are unlikely to replace full-fledged drug treatment.

• Aconite - is used during an acute attack with severe chest pain, rapid heartbeat, shortness of breath. The dosage of the drug is 8 granules up to 5 times a day.
• Spigelia - will help with a strong heartbeat, stabbing heart pain, radiating to the shoulder, jaw, neck. The drug is used from a few drops, to a dilution of a third to a thirtieth, depending on the severity of the broken heart syndrome.
• Arsenicum album - used for burning pain in the heart, accompanied by anxiety, increased sweating, thirst. As a rule, a low dilution of the drug is used - from 3 to 30. The exact dosage is determined by the doctor.
• Crategus - used in low dilutions for chest pain, shortness of breath, rapid heartbeat, edema of cardiac origin.

Prevention

Since the etiology of broken heart syndrome has not been thoroughly studied, there are no specific preventive measures to prevent the disease. However, experts have published a number of principles that will help strengthen the nervous system and resist sudden stressful situations.

1. The body needs measured and moderate physical activity. You should not completely give up physical exercise, nor overload yourself with exhausting exercises. The "golden mean" is important here.
2. Nutrition plays an important role in the prevention of many diseases. To prevent heart disease, you should reduce the consumption of animal fat, salt, and alcoholic beverages. Preference should be given to plant and dairy products, cereals.
3. It is no secret that nicotine promotes the development of irreversible changes in blood vessels, and also negatively affects the functioning of the nervous system and heart. Regular smoking can lead to ischemia of the heart muscle and arrhythmia. Therefore, it is better to give up such a harmful habit once and for all.
4. It is advisable to regularly visit a cardiologist and perform standard diagnostic procedures, such as an ECG. After all, it has long been known that any disease is easier to prevent than to treat. And broken heart syndrome is no exception.

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Forecast

If assistance is provided in a timely manner and the initial attack proceeds favorably, coronary function can be restored within 2 months.

Unlike myocardial infarction, which has similar symptoms, death after an attack of broken heart syndrome occurs much less frequently.

The prognosis of the disease can be improved by taking preventive measures to prevent stress. Sometimes the help of a psychologist may not be superfluous.

Broken heart syndrome is not only a unique name for a human condition, but also a serious illness that often requires an individual approach to treatment.

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