Broken Heart Syndrome

The syndrome of a broken heart is not just another metaphor, telling about an unsuccessful love story. This is a real diagnosis, which in medicine is also called stress cardiomyopathy, or Takotsubo cardiomyopathy. This disease is considered rare, and therefore not enough studied. Although many specialists tend to believe that the syndrome occurs much more often than it is diagnosed: its symptoms are often mistaken for signs of other cardiovascular pathologies.

Epidemiology

The syndrome of the broken heart develops mostly in female patients, and mainly after 60-70 years. According to statistical data, the bulk of patients are women from 62 to 76 years old.

The most frequent occurrence of the disease is the winter season, which is also characterized by the development of seasonal depressions.

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

[1], [2], [3], [4]

Causes of the syndrome of a broken heart

At the moment, the exact cause of the syndrome of a broken heart is not defined. We consider such versions as psychoemotional stress, emotional overstrain (mostly negative), which lead to an increase in the level of catecholamines in the bloodstream (especially in this case, the excess content of adrenaline).

Disturbance of the heart as a result of the release of stressful 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 simultaneous short-term constriction of the arterial vessels of the heart.

[5]

Risk factors

You can identify the main risk factors that can lead to the development of the syndrome of a broken heart:

• sudden loss of loved one or loved one;
• the manifestation of domestic violence, bullying and moral pressure in the work collective;
• a sudden financial collapse as a result of the loss of a significant amount of money (possibly as a result of fraudulent fraud);
• disaster, accident, terrorist act;
• the appearance of excessive physical or intellectual loads with an overestimated sense of responsibility;
• severe infectious, pulmonary, oncological diseases;
• severe surgical interventions.

Such conditions as constriction or spasm of the coronary arteries, atherosclerotic changes in the arterial blood vessels of the heart, as well as any diseases leading to deterioration of the blood supply to the myocardium, contribute to the development of the syndrome.

[6], [7], [8], [9]

Pathogenesis

According to the latest ideas, a fundamental psychoemotional or even physical overload is considered a fundamental factor in the development of the broken heart syndrome. Acute withdrawal of catecholamines and hypersensitivity of adrenoreceptors, nervous conduction disorder in the apex of the heart, somatic failure in the nuclei of the hypothalamus represent a reaction of the body to the received stress.

It is impossible to exclude the importance of a sharp physical overload and even a sharp and severe hypothermia in the mechanism of the development of the syndrome.

The mechanism of the onset and development of the syndrome of a broken heart has not yet been fully substantiated. In the state of discussion there is a number of theories according to which, in most cases, a spastic reduction of the coronary arteries occurs in the epicardium of the coronary blood flow. At the same time, microcirculation is disturbed. However, such theories have no experimental confirmation, so to date the pathogenesis of the disease is at the stage of study.

[10], [11], [12], [13]

Symptoms of the syndrome of a broken heart

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

• painful attacks located behind the sternum;
• difficulty breathing, shortness of breath (both at rest and after physical exertion);
• sometimes - lowering of blood pressure;
• sometimes - heart rhythm disturbances;
• sensation of a sharp 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 with myocardial infarction the symptoms remain pronounced for a much longer time. In cases where the pain is severe and gives under the scapula, to the shoulder joint, forearm, neck or jaw, then urgent medical attention should be urgently and urgently required.

Stages

The syndrome of a broken heart is divided into several stages. Since the origin of the pathology may not manifest itself by any signs, the initial stage can be characterized as the initial stage of the beginning of vegetative disorders.

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

[14]

Forms

In addition, there are certain types of heart damage. 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 the syndrome of a broken heart develops repeatedly, or against its background there are other pathologies of the heart and blood vessels.

[15], [16], [17], [18]

Complications and consequences

The development of the syndrome of a broken heart can result in the appearance of all kinds of complications, including those that can be dangerous for the patient's life.

The most threatening complications of the syndrome of a broken heart can be:

• insufficiency of cardiac activity, which is accompanied by a gradual decrease in cardiac output and a lack of oxygen in the tissues;
• acute myocardial infarction - development of necrosis in the myocardium due to oxygen starvation;
• violations of the heart rhythm are a consequence of a disruption in the structure of tissues, when bioelectric impulses lose the ability to "diverge" qualitatively in the heart muscle;
• thromboembolism can occur if there is a violation of intercamera 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 small circle.

In addition, it is possible that with another shock, the syndrome of a broken heart can occur repeatedly.

[19], [20]

Diagnostics of the syndrome of a broken heart

If you suspect a broken heart syndrome, the doctor can apply the following types of diagnosis:

• A survey and a general examination of the patient is carried out in order to clarify whether the patient has had a heart problem before, after what incident or case, the first symptoms appeared, etc. As a rule, most patients insist that they have not received any complaints about the heart's work .
• Blood tests may indicate an increase in the level of activity of certain enzymes, which does not correspond to the volume of the affected cardiac muscle:
  • troponin I - 85%;
  • MB-fractions of creatine phosphokinase - 73.9%.
• Instrumental diagnostics can include:
  • electrocardiography is a non-invasive study that, with the help of electrodes placed on the patient's body, helps to record cardiac activity;
  • chest echocardiography is a common diagnostic method that allows one to determine the ballooning effect in the apex region with occlusion of the left ventricular outflow opening, as well as the immobility of the anterior wall of the interventricular membrane;
  • ventriculography and MRI - help detect the immobility of certain parts of the left ventricle against the background of increased contractility in the basal departments. Violation of the right ventricular function is manifested by inactivity or immobility in the main apicalateral part;
  • Coronary angiography may indicate the presence of stenosis of the coronary arteries.

[21], [22]

Differential diagnosis

Differential diagnosis of the syndrome of a broken heart is a rather complicated process. The problem is, the symptomatology of the cardiovascular system has much in common, as with myocardial infarction, and with other varieties of cardiomyopathies. Sometimes the doctor is difficult to determine even the primary or secondary disease.

Difficulty in diagnosis often determines the tactics of conducting research, because only with the best possible information can you accurately put the right diagnosis and conduct the correct treatment.

[23], [24], [25], [26], [27], [28]

Treatment of the syndrome of a broken heart

The optimal and unified scheme for the treatment of the syndrome of a broken heart is still under development. As a rule, patients are prescribed medications that support cardiac activity and prevent the spasm of arterial vessels. Possible application:

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

	Dosing and Administration	Side effects	Special instructions
Ramipril	Take inside at 1.25-2.5 mg to 2 times a day.	Lowering blood pressure, pain in the head, weakness, frustration defecation, cough.	The drug is not used to treat patients under 18 years old.

	Dosing and Administration	Side effects	Special instructions
Carvedilol	Dosage is selected individually and can be from 12.5 to 25 mg twice daily after meals.	Allergies, headache, dizziness, sleep disturbances, peripheral circulatory disorders, shortness of breath, abdominal pain, thirst, indigestion.	Admission high to the drug can cause a sharp drop in blood pressure, which requires urgent measures.

	Dosing and Administration	Side effects	Special instructions
Cardiomagnet	Take from 2 to 6 tablets per day, depending on the condition of the patient.	Increased bleeding probability, anemia, sleep disorders, digestive disorders, allergies.	The drug should not be taken concomitantly with antacids and NSAIDs.

	Dosing and Administration	Side effects	Special instructions
Indapamide	Take 1 tablet inside in the mornings, with water.	Fatigue, headaches, lowering of blood pressure, thirst, cough, indigestion.	The drug is not prescribed for strokes, and children under 18 years.

	Dosing and Administration	Side effects	Special instructions
Nifedipine	Take 0.01-0.03 g to 4 times a day, for 4 to 8 weeks.	Redness of the face, pain in the head, lowering of blood pressure.	The drug is not prescribed at the expressed lowered arterial pressure.

In addition to medicines, to strengthen the heart and blood vessels it is necessary to take certain vitamins. They are necessary in order to prevent the further development and re-occurrence of the syndrome, as well as to accelerate the restoration of cardiac tissues.

What kind of vitamins will have the greatest benefit in the syndrome of a broken heart?

• Ascorbic acid - will strengthen the heart and prevent high cholesterol in the blood.
• Vitamin A - will improve metabolic processes in tissues and prevent atherosclerotic changes in the vessels.
• Vitamin E - will support cardiac function and help the damaged tissue to recover.
• Vitamin P - strengthens the vascular walls, facilitates blood circulation.
• Vitamin F - prevents the formation of atherosclerotic plaques in the vessels.
• Vitamin B1 - stimulates heart contractions.
• Vitamin B6 - will withdraw excess cholesterol.
• Vitamin-like substance Q10 - will improve the nutrition of the heart muscle, prevent aging of the myocardium.

Whether to accept the proposed vitamins in the form of mono or polypreparatov, the doctor will tell. In mild cases, you can get a sufficient amount of vitamins, just adhering to certain principles of nutrition, because a large number of nutrients a person gets with food.

Physiotherapeutic treatment

Physiotherapy with broken heart syndrome is usually aimed at restoring the normal function of the heart, improving the coronary circulation and contractility of the heart muscle, its sensitivity and automatism.

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

In the syndrome, the following physiotherapeutic procedures are often prescribed:

• Electrosleep - Electrotherapy method using pulsed currents of low frequency;
• galvanotherapy - therapeutic procedure using a continuous direct current;
• drug electrophoresis is a painless physiotherapy procedure that involves "delivering" the medicine directly to the tissue, bypassing the digestive tract and the circulatory system;
• ultrahigh-frequency therapy is a soft effect of high frequencies of the electromagnetic field on a certain zone or organ of the patient;
• Magnetotherapy - treatment with magnetic fields;
• microwave therapy - microwave therapy based on the use of electromagnetic radiation with a frequency of 300 MHz - 30 kHz.

Use hydrotherapy in the form of contrasting water procedures, underwater massage, shower. Such procedures stabilize the work of the autonomic nervous system, reduce the need for myocardium in oxygen, normalize metabolism in the heart tissues, expand the body's internal reserves, improve vascular reactivity.

Alternative treatment

Alternative healers claim that the broken heart syndrome can be successfully treated with alternative means, and some of these recipes are also recommended for preventive purposes.

1. Berry berries (fresh or dried) should be consumed every day, about 100 grams, washed down with clean water.
2. Pour 1 tbsp. L. Flax seed 1 liter of boiling water and insist for an hour. Infusion should be taken 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. L. Honey and 3 tsp. Lemon juice. Divide the mixture into three doses and take them 30 minutes before breakfast, lunch and dinner.
4. Pour 1 tsp. Rhizomes chicory 200 ml of boiling water, insist half an hour under the lid. Take infusion of ¼ cup to 4 times a day, daily.

It is possible to supplement the proposed treatment with herbal medicines.

[29], [30]

Herbal Treatment

In the syndrome of a broken heart, the use of such medicinal charges is shown:

• Mix 10 g of mint leaves, 5 g of valerian rhizome, 10 g of leaves of the watch and 5 g of hop cones. Pour the mixture 250 ml of boiling water and leave for 40 minutes. Take the medication throughout the day in small portions. Duration of treatment - up to 3 weeks.
• Prepare a mixture of 15 g of mint, 20 g of rhizome of valerian, 5 g of lily-of-the-valley flowers, 10 g of fennel. Pour the mixture 250 ml of boiling water 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. Insist 1 tbsp. Spoon mixture in 250 ml of boiling water. Take 200-250 ml at bedtime.
• Mix equal parts of chamomile, mint leaves, fennel seeds, valerian rhizomes, cumin seeds. Brew 1 tbsp. L. Mixture in 250 ml of boiling water, take overnight.

Homeopathy

Using homeopathy medications will help to remove pain during an attack of a 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 a full-fledged drug treatment such drugs are unlikely to replace.

• Aconite - is used during an acute attack with severe retrosternal pain, palpitations, dyspnea. Dosage of the drug is 8 granules up to 5 times a day.
• Spiegelia - will help with a strong palpitation, stitching heart pain, giving back to the shoulder, jaw, neck. The drug is used from a few drops, to dilution from the third to the thirtieth, depending on the severity of the broken heart syndrome.
• Arsenicum album - is used for burning pain in the heart, accompanied by anxiety, excessive sweating, thirst. Typically, apply a low dilution of the drug - from 3 to 30. The exact dosage is determined by the doctor.
• Krategug - used in low dilutions for chest pain, dyspnea, rapid heartbeat, edema of cardiac origin.

Prevention

Since the etiology of the 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 withstand sudden stressful situations.

1. The organism needs a dosed and moderate physical load. Do not completely abandon physical education, as well as overload yourself with debilitating 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 intake of animal fat, salt, spirits. Preference should be given to plant and sour-milk products, cereals.
3. It is not a secret for anyone that nicotine contributes to the development of irreversible changes in blood vessels, and also negatively affects the work 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 pernicious habit, once and for all.
4. It is advisable to visit the cardiologist regularly and perform standard diagnostic procedures - for example, ECG. It has long been known that any disease is easier to prevent than treat. And the syndrome of a broken heart is no exception.

[31], [32]

Forecast

With timely assistance and a favorable course of the initial attack, the coronary function can be restored within 2 months.

In contrast to the similar in symptomatic myocardial infarction, the lethal outcome after an attack of the syndrome of a broken heart is much less common.

The prognosis of the disease can be improved if you perform preventive measures to prevent stress. Sometimes it is not unnecessary to become a psychologist.

Syndrome of a broken heart is not only a unique name for the human condition, but also a serious illness, the treatment of which often requires an individual approach.

[33], [34]