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Senior Citizen Health & Medicine
New Registry of Broken Heart Syndrome May Help
Solve Mystery Condition
95% women, 60% experienced stress before going to ER
 May 10, 2007 - The causes of "broken heart
syndrome" remain a mystery, but doctors will soon have an easier time
recognizing and treating this rare, life-threatening condition, thanks
to data being reported at the 30th Annual Scientific Sessions of the
Society for Cardiovascular Angiography and Interventions (SCAI), May
912, 2007, in Orlando, FL.
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Health & Medicine |
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Researchers from Brown University in Providence,
RI, have developed the largest registry of patients in the United States
with Takotsubo cardiomyopathy, informally known as broken heart syndrome
because it is often preceded by an emotional or physical shock of some
kind and almost always strikes women.
One thing is certain: Patients are
usually critically ill during the first 48 hours.
"These patients can be difficult to manage for
emergency physicians and cardiologists alike," said cardiology fellow
Richard Regnante, M.D. "They may be in cardiac arrest, cardiogenic
shock, or severe heart failure. They may require advanced life support
with airway management and medications to support blood pressure."
In fact, based on symptoms, electrocardiographic (ECG)
tracings, and blood tests for heart damage, it often seems as if the
patient is having a heart attack. The mystery deepens in the cardiac
catheterization laboratory, when the interventional cardiologist finds
no blockage in the coronary arteries.
To date, the registry has enrolled 40 patients
diagnosed with Takotsubo cardiomyopathy at two major hospitals in Rhode
Island over a period of nearly 2½ years. Ninety-five percent were women,
and 60 percent experienced some type of stress shortly before coming to
the emergency room. The intensity of the stress varied dramatically,
however, ranging from armed robbery to a heated argument, tooth
extraction, or preparation for a colonoscopy.
"We don't know why some women develop this syndrome
after what appears to be minimal stress, while other women experience
severely stressful events but don't develop Takotsubo cardiomyopathy,"
Dr. Regnante said.
A surge of stress hormones likely plays a role, he
said, but it is also possible that a blood clot temporarily blocks a
major artery of the heart, then dissolves before being detected during
coronary angiography.
The most common symptom of broken heart syndrome
was chest pain, in 70 percent of patients, followed by shortness of
breath in 33 percent. All patients had ECG changes suggestive of an
acute coronary syndrome, a term that encompasses both heart attack and
unstable angina.
Troponin-I, a blood test for heart damage, was
positive in 95 percent of patients. Twenty percent of patients were
unable to breathe on their own and needed a respirator. In all patients,
cardiac catheterization showed characteristic abnormalities in the
motion of the heart. One patient died of acute heart failure.
The good news is that most patients who survived
the first 48 hours had a steady recovery. Thirty one, or 78 percent, of
patients had follow-up echocardiography within a few weeks. Heart
function was found to be normal in 29 of 30.
Dr. Regnante said that long-term follow-up will be
critical to improved understanding of Takotsubo cardiomyopathy. In
addition, he and his colleagues are gathering information on patients
who have intravascular ultrasound during cardiac catheterization.
This imaging test, in which a tiny ultrasound probe
is threaded into the coronary arteries on the tip of a catheter, may
show whether the patient has clogged arteries or unstable plaques that
are not visible on coronary angiography. These findings will help guide
long-term treatment.
"Because we don't yet know what causes this
phenomenon, we don't know what the best long-term management should
include," he said. "As we gather more information on these patients, we
can start to understand who is affected by Takotsubo cardiomyopathy,
offer more focused long-term care, and make predictions about their
outcomes."
About SCAI
Headquartered in Washington, DC, the Society for
Cardiovascular Angiography and Interventions is a 3,700-member
professional organization representing invasive and interventional
cardiologists in 70 nations. SCAI's mission is to promote excellence in
invasive and interventional cardiovascular medicine through physician
education and representation, and advancement of quality standards to
enhance patient care. SCAI's annual meeting has become the leading venue
for education, discussion, and debate about the latest developments in
this dynamic medical specialty.
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