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Although once thought to be the figment of a poet’s imagination, doctors now know it is possible to die from a `broken heart’ – from a condition known as Takotsubo cardiomyopathy – or stress induced cardiomyopathy. Also known as broken heart syndrome, this acute ballooning of the heart ventricles is a well-recognized cause of acute heart failure and dangerous cardiac arrhythmias.
Johns Hopkins Medicine has a Frequently Asked Questions about Broken Heart Syndrome, that describes the condition:
1. What is “stress cardiomyopathy?”
Stress cardiomyopathy, also referred to as the “broken heart syndrome,” is a condition in which intense emotional or physical stress can cause rapid and severe heart muscle weakness (cardiomyopathy). This condition can occur following a variety of emotional stressors such as grief (e.g. death of a loved one), fear, extreme anger, and surprise. It can also occur following numerous physical stressors to the body such as stroke, seizure, difficulty breathing (such as a flare of asthma or emphysema), or significant bleeding.
2. What are the symptoms of stress cardiomyopathy?
Patients with stress cardiomyopathy can have similar symptoms to patients with a heart attack including chest pain, shortness of breath, congestive heart failure, and low blood pressure. Typically these symptoms begin just minutes to hours after the person has been exposed to a severe, and usually unexpected, stress.
3. Is stress cardiomyopathy dangerous?
Stress cardiomyopathy can definitely be life threatening in some cases. Because the syndrome involves severe heart muscle weakness, patients can have congestive heart failure, low blood pressure, shock, and potentially life-threatening heart rhythm abnormalities. The good news is that this condition improves very quickly, so if patients are under the care of physicians familiar with this syndrome, even the most critically ill tend to make a quick and complete recovery.
Since this condition is normally associated with the sudden loss of a loved one, or some other form of severe stress, it shouldn’t come as a complete surprise research finds an increased incidence of this syndrome in stress filled post-disaster scenarios.
First a press release from the American College of Cardiology, after which I’ll return with a bit more.
Clusters of 'broken hearts' may be linked to massive natural disasters
Analysis of US Takotsubo cardiomyopathy cases shows pattern to cue emergency responders
WASHINGTON (March 27, 2014) — Dramatic spikes in cases of Takotsubo cardiomyopathy, also called broken heart syndrome, were found in two states after major natural disasters, suggesting the stress of disasters as a likely trigger, according to research to be presented at the American College of Cardiology's 63rd Annual Scientific Session. Authors call for greater awareness among emergency department physicians and other first responders.
Takotsubo cardiomyopathy, or broken heart syndrome, is a disorder characterized by a temporary enlargement and weakening of the heart muscle, which is often triggered by extreme physical or emotional stress – for example, being in a car accident or losing a child or spouse. Previous international studies have also linked broken heart syndrome to natural disasters, including the 2004 earthquake in Japan. This is the first U.S. study to examine the geographic distribution of the condition in relation to such catastrophes.
Researchers at the University of Arkansas identified 21,748 patients diagnosed with primary cases of broken heart syndrome in 2011 using a nationwide hospital discharge database. After mapping the cases by state, Vermont and Missouri emerged as having the highest rate of cases, with 380 cases per million residents in Vermont and 169 per million in Missouri. Most states had fewer than 150 cases per million residents. New Hampshire and Hawaii had the lowest rate of the disease that year.
The rate of broken heart cases in Vermont in 2011 was more than double most other states. This was the same year that Tropical Storm Irene pummeled the state with heavy rain and wind, causing the most devastation Vermont has experienced since the Great Flood of 1927. Similarly, researchers found broken heart syndrome at a rate of 169 cases per million in Missouri in 2011, the same year a massive tornado ripped through Joplin, Mo., demolishing neighborhoods and killing at least 158 people.
"Despite the seemingly increasing number of natural disasters we have, there is limited data about how it might affect the heart," said Sadip Pant, M.D., internist at the University of Arkansas for Medical Sciences, and lead investigator of the study. "Our findings suggest two disasters, one in Vermont and one in Missouri, might have been possible triggers for the clustering of Takotsubo cardiomyopathy cases in these regions."
We’ve looked at the post-disaster (often stress related) effects on human health previously, including earlier this month in Tulane University: Post-Katrina Heart Attack Rates – Revisited, where heart attack rates remain elevated by 300% in New Orleans six years after that hurricane struck.
And just last month, in The Long Term Effects Of A Major Disaster, we looked at the post-tsunami deaths due to stress and displacement that exceeded – at least in one prefecture – those experienced during the initial earthquake and tsunami. And last fall - in Sandy 1 Year Later: Coping With The Aftermath - we looked at the lingering psychological effects of New England’s brush with that late season super storm of 2012.
While often hidden from view, the psychological impact of a disaster can be enormous and ongoing. Last year in Post Disaster Stress & Suicide Rates we looked at the impact of disaster-related PTSD (Post Traumatic Stress Disorder). This has been recognized as such a pressing problem that last August the World Health Organization released a comprehensive Guidelines For Post-Trauma Mental Health Care book on the treatment of PTSD, acute stress, and bereavement:
While the psychological impact of a major disaster cannot be completely mitigated, encouraging individual, family, and business preparedness can go a long ways towards reducing the impact of any disaster.
Which is why FEMA, Ready.gov, along with organizations like the American Red Cross, spend so much time trying to convince individuals, families, businesses and communities of the value of preparing for a wide variety of emergencies and disasters.The bottom line is that those who follow the advice to Have A Plan, Make A Kit, and Be informed will be not only be better able to deal with a disaster, they will be better prepared to weather the rigors of a long recovery as well.
And that, in turn, could help reduce the risks of a variety of post-disaster health issues.
For more on all of this, a few of my (many) blogs on disaster preparedness include:
In An Emergency, Who Has Your Back? When 72 Hours Isn’t Enough When Evacuation Is The Better Part Of Valor
