Heart Attack or Broken Heart Syndrome?

In February 2015, Patricia was sitting on her couch, talking with some friends, when she noticed a slight burning sensation in her chest.

“The pain increased after they left, so I lay down for about an hour, then called my primary care physician,” she recalls. “My doctor said go immediately to the emergency department and get it checked out.

“When I got there and said I’d been having chest pain for close to two hours, boom — I was rushed in, hooked up to an IV and having tests within ten minutes,” Patricia continues. “Dr. Fitts walked in and said because the blood tests showed something was going on with my heart, he was sending me upstairs for a cardiac catheterization.”

“My initial concern was that she was having a heart attack related to a blocked artery,” explains Cardiologist James Fitts, MD, Board Certified in Nuclear Cardiology, Echocardiography and Cardiovascular Disease.  “[It is] what we typically see in situations where we have positive cardiac markers in the setting of chest pain,” says Dr. Fitts, referring to troponin, a protein released into the bloodstream during a heart attack.

“We performed an echocardiogram right away to help determine what was going on, and she had the appearance of takotsubo cardiomyopathy,” he continues. “But we couldn’t prove that was the problem until we did a diagnostic catheterization, since a severe blockage in the left anterior descending coronary artery could also make the heart look the way it did.”

Takotsubo cardiomyopathy or broken heart syndrome

Takotsubo cardiomyopathy — also referred to as broken heart syndrome, apical ballooning, or stress cardiomyopathy — is a condition in which the heart muscle becomes suddenly weakened or stunned and the left ventricle, one of the heart’s chambers, temporarily changes shape.

It can produce the same symptoms as a heart attack. Symptoms include chest pain, shortness of breath, irregular heartbeat, nausea, sweating, anxiety, and loss of consciousness or fainting. And, they’re not caused by coronary artery disease.

Without testing, however, there’s no way of knowing if these symptoms are the result of a heart attack or takotsubo cardiomyopathy, so they should be treated as an emergency.

Women aged 50-plus are most at risk

Takotsubo cardiomyopathy most often affects women aged 50 and older. It commonly occurs immediately after experiencing extreme emotional or physical stress — such as the sudden death of a loved one, a natural disaster or car accident.

It was first identified in Japan in 1990, and named “takotsubo” because during the acute phase of the syndrome, when the left ventricle balloons out, it takes on a shape that’s similar to a Japanese fisherman’s octopus trap (tako-tsubo).

Takotsubo has no known cause, however, research suggests that the sudden release of stress hormones (norepinephrine, epinephrine and dopamine) “stuns” the heart. This triggers changes in heart muscle cells which weaken the left ventricle and prevent it from pumping oxygen-rich blood throughout the body.

Typically triggered by an unexpected stressful event, over one-quarter of individuals with takotsubo cardiomyopathy have no clear triggers — which was the case in Patricia’s situation.

“We kept her in the hospital for two days. We gave her medications, including a beta blocker and ACE inhibitor, to protect and help improve her cardiac function,” Dr. Fitts relates. Under his care, she eventually was weaned off the medications after her heart returned to normal.

“Don’t self-diagnose if you’re having chest pain”

“As in the majority of cases, her heart sustained no permanent damage. The left ventricle’s ballooning subsided within a few weeks,” Dr. Fitts says. “In most patients, complete recovery usually occurs within three months, and this condition is rarely fatal,” he notes.

“I continue to see her and perform periodic echocardiograms, and everything remains normal,” he adds.

“If I could give other women advice, I’d say don’t self-diagnose if you’re having chest pain,” Patricia says. “If I’d stayed on my couch, it could have created major problems. Thankfully, I didn’t have a heart attack, but my husband died of one. We have to realize we’re as vulnerable as men are.”

“Heart disease is the number-one cause of death in women,” Dr. Fitts affirms. “Symptoms shouldn’t be ignored. Chest pain brought on by exertion and relieved with rest is a hallmark for cardiovascular disease in both women and men. That’s unlikely heartburn, and you should seek medical attention right away.”

More research needed

“There needs to be more research in this area so we understand the mechanisms in play,” Dr. Fitts says, noting that estrogen, or the lack thereof, may be a factor.

“Endogenous estrogen, which refers to the natural form of estrogen in the body, is considered to have a protective effect on the heart. [This] is why coronary disease often presents in women after menopause.”

He also acknowledges that the symptoms of heart disease — particularly a heart attack — can present differently in women than men. This underscores the single-most important piece of advice he gives women:

“Don’t ignore symptoms,” he stresses. “Any symptom that can’t be readily explained should be evaluated. Shortness of breath, for example, could be a chest pain equivalent when it comes to coronary disease. Granted, chest discomfort could be acid reflux or a pulled muscle. But, we want to always make sure there’s no cardiac source.”