October 20, 2021-As a pediatric nephrologist, Elaine S. Kamil, MD, is used to helping children and adolescents solve various problems for a long time, some of which are very serious, and also take time to give back to her profession.
At the end of 2013, she planned a meeting of the American Society of Nephrology in Washington, DC. When the organizer decided at the last minute that another meeting was needed, she stayed late and put it together. Then she jumped on the plane and returned to her home in Los Angeles on Saturday night.
Just after midnight, Camille knew something was wrong.
"I have very severe chest pain," she said. "I have reflux, I know what it feels like. It's more intense. It really hurts." She argued, "Should I wake up my husband?"
Soon, the pain became so severe that she had to do it.
In the hospital, the electrocardiogram and blood tests to measure heart damage are somewhat abnormal. Next, she got angiography, an imaging technique that visualizes the heart. Once the doctor looks at the image on the screen during the angiogram, they will know the diagnosis: broken heart syndrome, medically called takotsubo cardiomyopathy or stress-induced cardiomyopathy. As the name suggests, it is caused by extreme pressure or loss.
A common symptom is chest pain, which seems to be caused by a heart attack, shortness of breath, and fainting. The clue to the diagnosis is the appearance of the left ventricular wall of the heart, which is the main pumping chamber. When this happens, the left ventricle changes shape, forming a narrow neck and a round bottom, similar to the octopus pot called the octopus pot used by Japanese fishermen. This situation was first discovered in 1990.
Like most people affected, Camille, now 74, is fine now. She is still actively working as a researcher and professor emeritus at the Cedars-Sinai Medical Center and a clinical professor of pediatric health sciences at the University of California, Los Angeles. But she is now more focused on reducing stress.
Research: Ascent conditions
New research by Cedars-Sinai shows that although heartbreak syndrome is not common, it is not as rare as people think. It is on the rise, especially among middle-aged and elderly women.
The study’s lead author, Susan Cheng, MD, published in the American Heart Journal, said that this “middle” group—women between 50 and 74 years old—had the highest growth rate in the study from 2006 to 2017. She is the director of the Institute of Healthy Aging at the Schmidt Heart Institute of Cedars-Sinai Medical Center.
Cheng and her team used national hospital inpatient data collected during a 12-year study period from more than 135,000 men and women diagnosed with the disease. More than 88% of all cases are women, especially women 50 years of age or older. When the researchers looked more closely, they found that the diagnosis rate for women in the 50 to 74 age group increased at least 6 to 10 times faster than in any other group.
For each case of young women or men of all age groups, the researchers found another 10 middle-aged women and 6 older women. For example, although the syndrome occurs in 15 young women per million people each year, it occurs in 128 middle-aged women each year.
Zheng said that the highest-risk age group is surprising, and she expects the oldest women (over 75 years old) to be at the highest risk.
She said that although doctors are now more aware of this situation, it is "not just an increase in awareness." "Something happened" promoted sustained growth. She said that this may be related to environmental changes.
She said that the hormonal and hormonal differences between men and women are not all. Her team will study it further, hoping to finally find out who is more likely to suffer from this disease by talking to people with this disease and collecting clues. "There may be some underlying genetic predispositions," she said.
"The neurohormones (such as adrenaline) that drive the flight or fight response will definitely rise," she said. "The brain and the heart are talking to each other."
Experts say that these surges in stress hormones essentially "shock" the heart and affect its function. The question is, what makes women particularly vulnerable to overstimulation when under pressure? Cheng said that this is still unclear.
Although this situation is a terrible experience, "the overall prognosis is much better than a normal heart attack," she said.
But the researchers are still figuring out the long-term results, and she can't tell patients if they might have another attack.
Research results reflected in practice
Other cardiologists said they were not surprised by the new findings.
"I think this is very consistent with what I see clinically," said Tracy Stevens, MD, a cardiologist at the St. Luke's Central American Heart Institute in Kansas City, Missouri. She said that in the past 5 years, she had diagnosed at least 100 cases. She agreed that this increase was partly but not entirely due to increased doctors’ awareness of the situation.
Stevens said that if a postmenopausal woman comes to the hospital for chest pain, she is more likely to suspect this condition now than in the past. Stevens said she is also a member of the Muriel Kaufman Women’s Heart Center at St. Luke University. Medical director. The image of an octopus pot is hard to miss.
"What we see at the bottom of the left ventricle is that it is squeezing like crazy, it is expanding."
"We may see it at least 5 to 10 times a month," said Kevin Bybee, an associate professor of medicine at the University of Missouri Kansas City School of Medicine.
He said the increase in the number found by the Los Angeles researchers may not even reflect how many people have the disease. He suspected that some women who died of sudden cardiac death might actually have broken heart syndrome.
"I always wanted to know how many people did not go to the hospital."
Bybee is also the medical director of Cardiovascular Services at St. Luke South in Overland Park, Kansas. During the study at the Mayo Clinic, he became interested in the syndrome when he diagnosed three patients in just 2 months. He and his team published the medical histories of 7 patients in 2004. Since then, more reports have been published.
Researchers in Texas used the same national database as the Cedars researchers to look at cases from 2005 to 2014 and also found an increase. But Abhijeet Dhoble, MD, a cardiologist and associate professor of medicine at the University of Texas Health Sciences Center and Herman-Texas Medical Center in Houston, co-author of the study, believes that more recognition can explain most of the growth. .
He said the pandemic is now playing a role in increasing cases.
"In the past two years, we have noticed an increase in the number of cases, probably due to the pandemic," he said.
Over the years, Bybee has collected information about what was happening before the heart began to lose control.
"15% to 20% of the time, there is no obvious trigger," he said.
Other times, stressful emotional events, such as death or spouse or serious car accident, may trigger it.
A patient who was extremely afraid of public speaking had to give a speech in front of a large group of people when he first started working. Bybee said that another woman had lost money at the casino before the incident. Another patient took her dog out for a walk in the woods. The dog was caught by a raccoon trap.
Bybee said that fierce arguments and unexpected gatherings caused this situation. Physical problems, such as asthma or sepsis, a life-threatening complication of infection, can also cause heartbreak.
"This is challenging because it is unpredictable," he said.
Experts at Harvard and the Mayo Clinic say that this condition is rarely fatal, but some people may experience complications such as heart failure.
Dhoble of Memorial Hermann said there are no standard treatment guidelines. "We give drugs to keep blood pressure in the optimal range." Doctors may also prescribe lipid-lowering drugs and blood thinning drugs. "Most patients will recover within 3 to 7 days."
"Usually within a month, their [heart] function returns to normal," Stevens said.
As Camille discovered, it may take longer to restore a person's full energy. "It will be about 6 months before I can keep up."
In retrospect, Camille now realized how much pressure she was under before the attack.
"I take care of children with chronic diseases," she said, worrying about them. "I'm a bit like a hen."
In addition to patient care and her inter-county meeting plan, she also flew to Florida to care for mothers with chronic health problems. She also managed the annual media award at a university in San Diego, which she and her husband set up a few years ago after the death of their adult son.
"I'm busy with this, it's a bittersweet experience," she said.
She is trying to slow down as recommended by a cardiologist.
"I used to be notorious for saying'I need to do one more thing'," she said.
Joanne Simpson said she also slowed down. After a series of stressful events, she was diagnosed with heartbreak in 2016. Her son is facing back surgery, her son-in-law is unemployed, and her little Yorkshire terrier Meha is also dead. She and her husband Benny also had problems with their rental property.
Now 66 years old and retiring at Wood Camp, Texas, she has learned to enjoy life and reduce worries. Music is a way.
"We are Parrotheads," she said, referring to the nickname given to fans of singer Jimmy Buffett. "We listen to Buffett and music from the 60s, 70s, and 80s. We dance around the house. We are not regulars in the big tavern, so we dance in the living room, hoping we won't fall off the coffee table. So far Good."
They plan to buy a small pontoon to go fishing. Benny particularly liked the idea, she said with a smile, because he found this was the only time she stopped talking.
Patients have a common question and concern: what if it happens again?
"I must be more worried about it at first," Camille said. "Will I have permanent heart damage? Will I become a paralyzed person?" Her worries eased.
If you suspect this situation, "let yourself find a provider who knows it," she said.
Bybee said cardiologists are likely to suspect this, as do doctors who work in large emergency departments.
Stevens of St. Luke's Hospital was straightforward, telling her patients what was known and what was not about the condition. She advised her patients to go to a cardiac rehabilitation center.
"It gives them confidence to know what they can do," she said.
She also provides lifestyle advice and advises patients to obtain a home blood pressure cuff and use it. She recommends paying attention to good nutrition and exercise, and not lifting heavy objects that require grunting.
Focusing on protecting heart health, Zheng told the patient. She encourages them to find a stress relief plan that suits them. Most importantly, she told patients to understand that it was not their fault.
Elaine S. Kamil, MD, Professor Emeritus of Pediatrics at Cedars-Sinai Medical Center; Clinical Professor of Pediatric Health Sciences at the David Geffen School of Medicine, University of California, Los Angeles.
Susan Cheng, MD, Director of the Institute of Healthy Aging, Smidt Heart Institute; Director of Cardiovascular Demography, Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles.
Cardiologist and medical director Tracy Stevens, MD, Muriel I. Kauffman Women’s Heart Center, St. Luke’s Central American Heart Institute, Kansas City, Missouri.
Kevin Bybee, MD, associate professor of medicine at the University of Missouri Kansas City School of Medicine; Medical Director of Cardiovascular Services at St. Luke South, Overland Park, Kansas.
Abhijeet Dhoble, MD, Director of Structural Heart Interventions, Cardiologist and Associate Professor of Medicine, University of Texas Health Sciences Center and Hermann-Texas Memorial Medical Center in Houston.
Joanne Simpson, Wood Camp, Texas.
Harvard Health Press: "Takotsubo Cardiomyopathy (Broken Heart Syndrome).
Mayo Clinic: "Broken Heart Syndrome."
Journal of the American Heart Association: "The incidence of Takotsubo syndrome in the United States is based on time trends in gender and age."
American Journal of Cardiology: "Trends and effects of using mechanical circulatory support to treat cardiogenic shock secondary to Takotsubo cardiomyopathy."
Annals of Internal Medicine: "Systematic review: Transient left ventricular apical ballooning: A syndrome that mimics ST-segment elevation myocardial infarction." Clinical aspects of myocardial injury: From ischemia to heart failure: "Takotsubo caused by multiple vasospasm Cardiomyopathy".
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