Back in the 1970s, when the Bee Gees sang “Please help me mend my broken
heart,”
no one took them literally. After all, a “broken heart” has
always been considered an emotional reaction, not a medical
condition. Now, newly published research from the Minneapolis
Heart Institute Foundation (MHIF) proves that an emotional
event can have a profound and harmful physical impact on
the human heart. The study, led by Minneapolis Heart Institute
cardiologist Dr. Scott Sharkey and funded by MHIF, concluded
that an emotional stress can “stun” the human heart.
The medical name for the condition is stress cardiomyopathy,
but many now refer to it as the “broken heart”
syndrome. The condition closely mimics a heart attack: patients
experience chest pain, shortness of breath and other symptoms
of a heart attack. Women over age 50 are especially vulnerable.
The Mind-Body Connection
In a paper published in Circulation, Sharkey and his colleagues
presented information on 22 Minnesota women who had symptoms
of a heart attack a short time after experiencing a stressful
event, such as the death of a relative or close friend, heated
arguments or financial reversals. (It wasn’t always a negative
event, however –
one woman experienced symptoms after a surprise party in
her honor.)
Although these women’s hearts weren’t beating
normally, they showed none of the other traditional characteristics
of a heart attack, such as a blocked artery or permanently
damaged heart tissue.
“We think that the emotional event each woman experienced
resulted in an overload of stress hormones, which in turn
caused the heart to be suddenly overworked,” said Sharkey. “It
shows what a powerful connection the brain has on the physical
wellness of a person.”
Until recently, the body of knowledge related to this
syndrome primarily focused on Japanese women. Now,
the MHIF study, along with a similar study conducted by
Johns Hopkins University in Maryland, indicates that the
syndrome affects women in the United States as well.
Since the MHIF study began in 2001, Abbott Northwestern
Hospital has treated several women each
month who appear to be affected by the syndrome. “As
many as three percent of the women who came to the
Emergency Department with heart attack symptoms
actually were suffering from stress cardiomyopathy,” said
Dr. Sharkey. All but one of the patients in the MHIF
study were women over 50 years of age.
It’s not completely clear why older women seem to be
more vulnerable to stress cardiomyopathy, but it does
point to differences between men and women in how
they react to stress. “The physiological differences
between men and women include their reaction to stress,
particularly emotional stress,” said Sharkey.
One Woman’s Story
Alice Denn of New Ulm has experienced the “broken
heart” syndrome first hand. She was 67 when she was
startled one morning in August 2003 with the news that
her younger brother had died in his sleep.
“I was fine for a while,” Denn remembered. “I went
over to my brother’s farmhouse several times to check on
my sister-in-law and bring meals. But on the way back
home from bringing her supper, I started feeling funny –
weak and all hot and sweaty.”
She arrived home and got out of the car – and that’s
the last she remembers until waking up as she was being
taken to Abbott Northwestern Hospital by helicopter. Her
son, who had driven her home, told her she actually went
into her house and then collapsed. He called 911 and
Denn was taken to the New Ulm Medical Center before
being transferred to Abbott Northwestern.
“At New Ulm, they thought I had either already had
a heart attack or was about to,” she said. When an angiogram
at Abbott Northwestern showed no arterial blockage
and an MRI showed no heart damage, Denn was instead
treated for stress cardiomyopathy and became part of
the study.
“It was quite a relief that I didn’t need surgery,” said
Denn, who was prescribed medications to reduce her
symptoms and also received cardiac rehabilitation back in
New Ulm. “I asked the doctor at Abbott Northwestern if
this heart problem would have happened if it hadn’t
been for the stress of my brother’s death. He said
probably not.”
Treating a Broken Heart
It’s important to distinguish between a heart attack and
stress cardiomyopathy so that the appropriate treatment
can be administered. As in Denn’s case, tools include
angiograms to identify blockages, and cardiac MRIs,
which provide three-dimensional images of the heart.
“When there has been a real heart attack from a
blocked artery, the dead or damaged tissue lights up like
a Christmas tree on the MRI,” explained Sharkey. “When
it’s stress cardiomyopathy, you rarely see any permanent
damage, even though the heart is not contracting properly.
It’s as though the heart has been temporarily stunned.”
“Although these people are not experiencing a typical
heart attack, the symptoms are real and need to be treated,”
continued Sharkey. “These patients are often critically
ill, some with very low blood pressure. Many require
temporary mechanical support of blood pressure and
breathing.”
With proper treatment, almost all people with stress
Minneapolis Heart Institute Foundation | InTouch Summer 2005
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cardiomyopathy fully recover, with no permanent heart
damage. Without appropriate treatment, it’s actually possible
for someone to die of a “broken heart.”
One reason it’s important to identify the presence of
stress cardiomyopathy is that treatment is often the opposite
of what is appropriate for a heart attack. For example,
with stress cardiomyopathy, appropriate treatment can
include drugs that block adrenaline and related hormones.
Conversely, physicians sometimes use adrenaline-type
drugs as a stimulant when treating patients for a typical
heart attack. Thrombolytic (clot-dissolving) therapy is also
a common heart attack therapy that should be avoided
with stress cardiomyopathy, since there generally is no
arterial blockage associated with stress cardiomyopathy
and because these blood-thinning drugs have a potential
side effect of stroke.
What’s Ahead
MHIF’s stress cardiomyopathy research study is an ongoing
project. It now includes data from more than 40
patients, providing the largest body of experience in the
world from a single institution.
“We are now working on methods of identifying these
patients earlier in the process,” said Sharkey. “We hope to
educate primary care physicians, nurses and Emergency
Department staff of this condition and ways to recognize
it when the patient seeks medical evaluation. We also
plan to investigate what is actually occurring when the
brain-heart interaction causes this problem.”
Whatever is uncovered, one thing is clear: the causes
and consequences of a broken heart are no longer
the sole province of poets and balladeers, but also a compelling
subject for cardiac research.
The Research Team
It takes a team effort to accomplish
a successful research study.
When MHIF’s stress cardiomyopathy
study, “Acute and
Reversible Cardiomyopathy
Provoked by Stress in Women
from the United States,” was
published in Circulation in
February 2005, seven co-investigators
were listed.
“The team on this study is
incredibly talented,” said Dr.
Scott Sharkey, the principal
investigator. “Dr. John Lesser
coordinated all of the cardiac
MRI work after spending several
months in London learning
more about cardiac MRI. I think
we now have the finest cardiac
MRI in the United States, bar
none. We would not have been
able to perform this work without
Lesser and his MRI crew,
including Dr. Terry Longe and
Jana Lindberg, RT, who, along
with Lesser, are listed as coinvestigators.”
Sharkey also credits Dr. Barry
Maron and his staff for their
crucial participation in the
study. “Dr. Maron of the
Minneapolis Heart Institute’s
Hypertrophic Cardiomyopathy
Center is world-renowned for
his work in cardiomyopathy.
He, along with his researcher
Andrey Zenovich, MSc, was
instrumental in analyzing the
data and producing the manuscript,”
said Sharkey.
“In addition, the Minneapolis
Heart Institute cardiologists
and nurses notified us whenever
a potential patient was
hospitalized,” concluded
Sharkey. “This was, and continues
to be, truly a team effort.”
