Stress cardiomyopathy is also known as broken heart syndrome. It is a sudden onset of cardiac dysfunction. The symptoms are similar to the symptoms of a heart attack.
What is stress cardiomyopathy?
Synonyms for stress cardiomyopathy are broken heart syndrome, tako-tsubo cardiomyopathy, and transient left ventricular apical ballooning. Stress cardiomyopathy occurs predominantly in older women. Similar to a heart attack, the disease causes chest pain, anxiety and nausea. For what is the definition of catatonic schizophrenia, please visit healthknowing.com.
Stress cardiomyopathy was first described as an independent disease in 1991. According to the definition of the American Heart Association (AHA), it is one of the acquired cardiomyopathies. The cause has not yet been fully clarified. Normally, the disturbed heart function is restored after a few weeks. In the acute stage, however, stress cardiomyopathy can also be fatal.
Causes
The pathogenesis of stress cardiomyopathy is not fully understood. Elevated levels of adrenaline and noradrenaline in the blood were found in many patients admitted to the clinic with stress cardiomyopathy. Metanephrine, normetanephrine and vanillin mandelic acid were also found in increased concentrations.
The concentration was even higher than after an actual heart attack. It is believed that these stress hormones are the cause of stress cardiomyopathy. Symptoms resembling those of stress cardiomyopathy have also been observed in patients with pheochromocytoma. Pheochromocytoma is a tumor that produces catecholamines and is associated with similarly high levels of stress hormones.
Since there seems to be a familial accumulation, a genetic predisposition is discussed. Viruses are also suspected of promoting the development of stress cardiomyopathy. It is assumed that the increased stress hormone level leads to a spasm of the coronary arteries and thus to a reduced supply to the heart. Calcium overload may also occur.
Where exactly the increased hormone levels come from can only be guessed at so far. The autonomic nervous system may overreact in stressful situations and produce too many hormones. A lack of estrogens during or after menopause can activate the sympathicotonic nervous system to an increased extent.
This would explain why only older women are affected by the disease. It is assumed that the circulatory disorders in the muscle areas near the heart apex are based on a different density of the beta-adrenoreceptors. Beta-adrenoceptors are activated in particular by the hormone adrenaline.
Symptoms, Ailments & Signs
Stress cardiomyopathy starts suddenly with severe chest pain and shortness of breath. The affected women feel a spasmodic pressure or a tearing in the heart area. The typical pain location is behind the breastbone. However, the pain can also radiate to the entire chest, shoulders, upper arms, upper abdomen and back.
Those affected also complain of shortness of breath and the feeling that the chest is narrowed. They suffer from sweating and anxiety. In the acute stage, stress cardiomyopathy cannot be distinguished from a heart attack. It is characteristic of the disease that the symptoms usually appear shortly after a psychologically stressful event. Typical events are the death of a family member, a mugging, an accident or the loss of a job.
But exciting and happy news can also trigger stress cardiomyopathy. Initially, stress cardiomyopathy was considered harmless. It is now known that serious complications can occur, especially in the first few hours. Cardiogenic shock develops in around 15 percent of all patients.
Nine percent experience serious cardiac arrhythmias. As a rule, however, the changes in the heart disappear completely within a few weeks. The changes in the ECG also disappear. Recurrences are very rare.
Diagnosis & course of disease
On physical examination, everything may appear normal at first. You may have the same signs as heart failure. These include, for example, rales over the lungs or a third heart sound. The diagnostic criteria include a temporary movement disorder of the left ventricle. This does not correspond exactly to the supply area of the associated coronary artery.
Severe narrowing of the coronary arteries must be ruled out. The ECG shows changes in the stimulus conduction as in a heart attack. The ECG shows elevations in the ST segment or changes in the T-wave region. In some cases, a prolongation of the QT interval can also be observed. It must be possible to place the symptoms of stress cardiomyopathy in a temporal context with a stressful or emotionally stressful situation.
Chest x-rays are normal or show pulmonary edema secondary to acute heart failure. Movement disorders of the left ventricle can be detected on echocardiography. This phenomenon is called apical ballooning. This contraction disorder usually leads to immobility or paradoxical mobility of the apex of the heart.
In stress cardiomyopathy, coronary angiography cannot detect any narrowing or blockage of the coronary arteries. With this finding, stress cardiomyopathy can be safely differentiated from myocardial infarction. Using magnetic resonance tomography, the movement disorder of the heart muscle and the absence of scarring can be shown very well.
Complications
In the worst case, stress cardiomyopathy can lead to the death of the patient. However, this only occurs if the symptoms are not treated immediately by a doctor. Those affected primarily suffer from shortness of breath and also severe pain in the chest. The symptoms are similar to the symptoms of a heart attack, so that many of those affected also suffer from fear of death or inner restlessness.
In many cases, the pain in the chest also spreads to the back. Sweating and heart problems also occur. Those affected appear tired and worn out and can no longer easily carry out normal activities or sports. Stress cardiomyopathy has a very negative effect on the patient’s quality of life. In most cases, complications only occur if the cause of the stress cardiomyopathy is not treated.
When treating the disease, the symptoms can be limited with the help of medication. However, it is also necessary to eliminate the stress trigger in order to limit the complaint completely. With successful treatment, stress cardiomyopathy does not usually result in a reduced life expectancy for the patient.
When should you go to the doctor?
In the case of stress cardiomyopathy, the affected person is dependent on treatment by a doctor. Further compilations can only be prevented by correct and, above all, early treatment. If stress cardiomyopathy remains untreated, it can even lead to the death of the affected person in the worst case.
Therefore, in the case of stress cardiomyopathy, a doctor must be consulted at the first sign. A visit to a doctor is necessary if the person concerned suffers from severe shortness of breath and severe pain in the chest. As a rule, there are also outbreaks of sweating and strong feelings of fear, up to and including fear of death. If these symptoms occur, a doctor must be consulted immediately. These symptoms can also occur in stressful situations.
In most cases, stress cardiomyopathy is treated by a cardiologist. In emergencies or in the case of very severe symptoms, an ambulance can be called or a hospital can be visited directly. Whether stress cardiomyopathy can be completely treated cannot be universally predicted. The patient’s life expectancy may also be reduced as a result of the disease.
Treatment & Therapy
There is currently no standard therapy for stress cardiomyopathy. Since the complication rate is very high, the patients are monitored in the intensive care unit. Unlike in the case of a heart attack, catecholamines are not administered. An intra-aortic balloon pump (IABP) may be used. In stable patients, beta-blockers can be administered. Alpha blockers are used analogously to the treatment of pheochromocytoma.
Prevention
Since the exact development mechanisms have not yet been clarified, there is currently no effective prophylaxis. However, if you experience chest pain and shortness of breath, you should go to a hospital as soon as possible.
Aftercare
Stress cardiomyopathy is also known as broken heart syndrome. It can occur in acute stressful situations as well as chronically and thereby weaken the heart muscle. Depending on the cause of the event, the aftercare is designed accordingly. Long-term treatment with beta-blockers is often necessary to relieve the heart.
Sometimes additional psychotropic drugs such as antidepressants and other stress-relieving drugs are used. It is also important in aftercare after the acute onset of symptoms to keep the stress hormone levels in the patient’s body low. They cause the heart muscle to be overloaded and stress cardiomyopathy can occur again and again if the levels are too high or result in a chronic long-term disease.
Follow-up care is to be carried out by a cardiologist and should be carried out over a longer period of time. At regular intervals, the specialist will check blood values and other heart parameters, for example using an ECG, and assess the condition of the heart accordingly. For the affected person, the aftercare also applies to reducing stress in everyday life in the long term.
All serious stressors put too much strain on the heart of patients with stress cardiomyopathy. The patient should seek advice on any ways in which he or she can help improve the condition. This can be, for example, relaxation techniques that you can learn.
You can do that yourself
In everyday life, reducing emotional and physical stressors to a minimum has proven to be helpful. The design of everyday processes must be tailored to the needs of the organism and the person concerned.
Physical overload or situations of physical strain are to be minimized. Additional breaks should be taken as soon as the first physical irregularities occur. Optimal sleep hygiene is required for the regeneration of the organism. For this reason, the sleeping utensils, the sleeping environment and the sleeping rhythm should be checked. In some cases, corrections are necessary to enable a more restful and deeper sleep.
In order to create an emotional balance, conflict situations in everyday life should be avoided or, if possible, resolved calmly and confidently. Disputes, hectic activity or the influence of noise can be perceived as negative and put a strain on the organism. The processing of strokes of fate should be done with the help of a psychotherapist.
In addition, communication about emotionally stressful situations and events is important. A stable social environment, friends and good communication partners help in moments of emotional overload. A regular mental review of the goals achieved in life and of the wishes and dreams is advisable. Becoming aware of the discrepancies can often lead to difficulties. Therefore, a factual summary of the developments should be made.
