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BROKEN HEART SYNDROME

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Introduction
Broken heart syndrome is a heart condition due to temporary stress, such as the stress one experience at the time of death of one’s loved ones.
People with broken heart syndrome have sudden chest pain. They think they are having a heart attack. This condition can also occur in case of intense emotional or physical stress like fear, grief, extreme anger, surprise.
Physical stress like seizures, stroke, bleeding and difficulty in breathing can also cause this condition. These symptoms of broken heart syndrome are caused by the reaction of the heart to an elevation in the stress hormones. In the broken heart syndrome, a part of your heart does not pump well and enlarges temporarily, while the rest of the heart contracts normally or even with more power.

 

Pathophysiology
It affects females of middle aged or post menopausal more than males.
Most heart attacks are a complete or substantially complete blockage of an artery of the heart caused. This blockage is caused by a blood clot at the site of due to the accumulation of fat (atherosclerosis) in the arterial wall.


In the broken heart syndrome, the arteries of the heart are not blocked. Blood flow from them although may be reduced. The exact cause of the broken heart syndrome is still not very clear. It is thought that an increase of stress hormones such as adrenaline, may temporarily damage the hearts in some people.


Multiple temporary narrowing of the arteries of the heart is seen as the cause by some groups. However they do not correlate always with areas of the heart affected. This theory is named as Transient Vasospasm.


The Left Anterior Descending Artery (LAD) is the artery supplying the anterior wall of the left ventricle of the heart. If it also surrounds the apex, then it can also supply the apex and the inferior part of the heart. Disturbance in this artery is considered as the possible cause by some groups. This theory is called as Wraparound Theory. This anatomical variant is not common to explain the cases.


Microvascular Dysfunction is a theory proposed by some which says that there may be some dysfunction in the coronary arteries at the level that the changes are not visible in the angiography.


Also Mid Ventricular Obstruction, Apical Stunning is considered as an important factor.

 

Causes & Risk factors
These are some of the events that can cause broken heart syndrome
News of unexpected death of loved ones
A medical diagnosis that has poor prognosis or potentially fatal
Domestic abuse
Losing lot of money
A surprise party
Public performance
Physical stressors such as an asthma attack, infections, car accident or major surgery

 

Symptoms & Signs
Broken heart syndrome symptoms can mimic a heart attack. Common symptoms include:

  1. Chest pain
  2. Shortness of breath or breathing difficulty
  3. An irregular heartbeat or increased heartbeats
  4. Generalized weakness
  5. Fainting
However sustained chest pain can be ischemia of the heart. So if the chest pain continues for long then the patient is to be rushed to a hospital.
 

Tests & Diagnosis
Since the patient presents with chest pain, it is always advised to get some investigations done like

ECG of EKG (electrocardiogram)
Chest X-Ray
Echocardiogram
Cardiac enzymes

 

References and Internet Links

  1. http://en.wikipedia.org/wiki/Broken_heart
  2. http://www.mayoclinic.com/health/broken-heart-syndrome/DS01135
  3. http://www.hopkinsmedicine.org/asc/faqs.html
 

Treatment Options
The symptoms of broken heart syndrome can be treated and the condition usually returns within a week.

Reassurance is very vital in the treatment plan for these patients. Patients need to be reassured that it’s not a heart attack and that they are going to get recovered in a week or two.

 

Medical Treatment
No standard treatment guidelines available. Most physicians manage the patient on similar line as heart attack patient till diagnosis is reached otherwise.

  1. Angiotensin-converting enzyme (ACE) inhibitors
  2. Beta-blockers
  3. Diuretics
 

Complications Of Disease
In rare cases, broken heart syndrome is fatal. But for the most heart breaking experience of the syndrome recover quickly and have no effect.
Other complications of broken heart syndrome include:

  1. Disruptions in your heartbeats (A fast or slow heartbeat)
  2. Backup of fluid into your lungs (pulmonary edema)
  3. You may have broken heart syndrome again if you have another stressful event
 

Complications of Medical Treatment

  1. Easy bruising or bleeding
  2. Swollen hands or feet
  3. Confusion
  4. Depression
  5. Sore throat
  6. Rash
  7. Itching
  8. Swelling
  9. Dizziness
  10. Difficulty in breathing
 
 
 
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