What is broken heart syndrome?
Sudden emotional stress can precipitate a heart disease called ‘Broken Heart Syndrome’ or stress cardiomyopathy. It is a disease of the heart muscle, usually following a major stressful life event like loss of spouse or a dear one. Sometimes it can be associated with another acute illness as well. It may manifest with chest pain or breathlessness and ECG findings may mimick a heart attack. Ultrasound imaging of the heart (echocardiogram) shows a peculiar finding: ballooning of tip of the left ventricle (lower muscular chamber of the heart). Hence this condition is also called apical ballooning syndrome. Though symptoms often resemble that of a heart attack, there is no significant block in any of the coronary arteries (blood vessel carrying oxygenated blood to the heart muscle). Most cases of broken heart syndrome recover over a period of time and heart muscle function is fully regained. For some reason, heart rhythm abnormalities are less common in broken heart syndrome than in a heart attack of corresponding severity. Broken heart syndrome can occasionally be fatal. It may noted that an actual heart attack (myocardial infarction) can also be precipitated by a major emotional stress. But it is different from broken heart syndrome in that there is a blockage in one or more coronary arteries in case of heart attack.
How does stress cause heart disease?
Stress and heart disease has various aspects. Stress can lead to increase in risk factors for heart disease as well as precipitate symptoms in a hitherto silent heart disease. Most older persons have build up of plaques in the blood vessels of the heart (coronary arteries). When there is a sudden severe stress, heart rate and blood pressure can shoot up. This can lead to increase of shear stress on the fat plaques in the blood vessels of the heart. A small break may form in the covering of the plaque, exposing the inner cells. Blood components known as platelets adhere to these breaks in the inner surface of the blood vessels and initiate the formation of blood clots. Blood clots in turn block the flow of blood in the vessel, leading to damage of heart muscle known as heart attack.
Sudden stress can sometimes lead to a surge in the blood levels of certain hormones like adrenaline. These contribute to the surges in blood pressure and heart rate. In addition this can upset the heart rhythm leading to life threatening rhythm disorders (cardiac arrhythmia) which can sometimes cause sudden stoppage of the heart (cardiac arrest).
Another manifestation of stress in the heart is the ‘broken heart syndrome‘ or stress cardiomyopathy. This was initially described more in elderly females after sudden demise of their spouse. Part of the left ventricle (lower muscular chamber of the heart) becomes enlarged, giving it the name apical ballooning. This occurs in the absence of any blockage to the blood supply. Most of these cases do recover sooner or later. Stress cardiomyopathy has been described along with multiple other forms of stress other than bereavement.
Stress in general changes our life style and we may eat more of carbohydrate and fat. This has long term consequences like increase in body weight, blood sugar and blood pressure. These can further increase the chance of heart disease. Stress increases the blood pressure and blood sugar through hormonal influences even without a change in the diet pattern.