Broken Heart Syndrome. Is that even a real thing?
In 2019, a 65-year-old Italian woman went to her local dentist to take a tooth out. It was supposed to be a minor oral surgery. She didn’t even need to be put under — just local anesthesia around the tooth, and it gets plucked out.
No big deal, right?
Except for the fact that she fainted right after the dentist numbed her up. Maybe the dentist assumed it was because she wasn’t good with needles. But it quickly became clear that something much more serious was happening because she soon went into Cardiac Arrest. And as EMTs frantically attempted to revive her, the most urgent questions became, what was happening to her? And why?
Broken Heart Syndrome
This was no HEART ATTACK.
This was something different. Harder to spot, more challenging to diagnose. But equally as dangerous. This was a real case of Broken Heart Syndrome.
“Broken Heart Syndrome” is a medical mystery that, let’s be real, sounds kinda fake. In addition to tracing the story of our Italian dental patient, we’re going to discuss how Broken Heart Syndrome was discovered, what it looks like, and who is at risk.
Your heart has 4 chambers, divided into left and right atrium and left and right ventricles. Separating them are valves. What you need to know is that the biggest chamber, the left Ventricle, is responsible for pumping oxygen-rich blood past the aortic valve and delivering it to all the organs of your body, except the lungs. Notice the shape of the Left Ventricle. What does that shape look like to you?
Here comes your fun fact.
Takotsubo in Japanese.
Breaks down into:
Tako – Octopus
Tsubo – Pot
Takotsubo actually isn’t a medical term. It’s a type of pot used by Japanese fishermen. When Japanese doctors first observed this condition, they took one look at that Left Ventricle and said, “Hey, that looks like one of those pots that catch octopuses!” But that’s what it looks like. Broken Heart Syndrome causes the Left Ventricle to swell up like a balloon down below, with a narrow neck above.
This takes us back to our 65-year-old Italian woman. How do we know she was suffering from this? Seven years before, she’d been admitted into the hospital with symptoms of chest pain and fainting. At the time, her echocardiogram, meaning an ultrasound of the heart, revealed that her left ventricle wasn’t pumping so well, and it also showed that the LV was ballooning down below with a narrowed neck.
More recent research has revealed that statistically, physical triggers cause a higher percentage of cases than emotional ones. A multi-year study published in the New England Journal of Medicine found that physical triggers, like accidents, broken bones, head trauma, major health complications like pneumonia or drug withdrawal, and surgery, are present in 1/3rd cases. Which is about the same number for emotional triggers as the cause. Also, about 1/3rd of cases have no apparent trigger at all. And this is a diagnosis that can be pretty tricky to pick up on.
Chest pain, nausea, fainting — those symptoms can occur with a much more common diagnosis, a heart attack. But while a heart attack involves the blood vessels in your heart getting blocked by plaque buildup, this is entirely different. And just as the Italian woman had done twice before when she was hospitalized for those symptoms, doctors need to image your heart by performing an echocardiogram, coronary angiography, or MRI to make the distinction.
But who is actually more likely to get this syndrome?
In a survey of over 1,700 patients with Broken Heart Syndrome, nearly 90% were women. Women are nine times more likely than men. Age is the other big one. The average age is 67. Patients with Broken Heart Syndrome were twice as likely to have been diagnosed with a neurologic or psychiatric disorder. Yeah, over half of the patients had a history of mental issues, which happened with this lady. At the dental appointment, she was taking benzodiazepines for an anxiety disorder.
But even if you fall into all of these demographics, that doesn’t necessarily mean you’ll get it, so just how common is it?
Between 2006 and 2017, slightly under 140,000 cases of Broken Heart Syndrome were reported in the United States. That’s about 13,000 cases a year. But keep in mind that increasing awareness of this condition means that the number of cases diagnosed every year is increasing. And because Broken Heart Syndrome is so hard to distinguish from a heart attack, many cases still go misdiagnosed, whether as a different acute coronary syndrome or sometimes as a simple panic attack.
Doctor Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine
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