July 9, 2013
It sounds too cute to be true — or, at least, too cute to be important. "Broken heart syndrome" is the name being given to the condition of 19 patients who developed heart failure after sudden emotional stress, as reported in The New England Journal of Medicine on Feb. 10, 2005, just in time for Valentine’s Day. The fact is that broken heart syndrome is probably real, but very, very rare. Nevertheless, its existence has some important messages for all of us about the relationship between stress, fitness and the heart.
First, a quick summary of what researchers from Johns Hopkins University School of Medicine described in their New England Journal paper. Nineteen patients came to them for help after suddenly developing severe heart problems — the usual symptoms were chest pain, shortness of breath, and/or light-headedness due to low blood pressure.
These symptoms were not psychological — the patients were severely ill. Echocardiograms (tests that use sound waves to provide images of the pumping heart) showed that their left ventricles (the main pumping chambers) were squeezing weakly. Only one had any evidence of atherosclerosis in their coronary arteries (buildup of plaque), so it was clear that heart attacks had not caused the damage.
What, then, was the problem? All 19 had just had a severe emotional stress within the previous 12 hours. Most had received sad, tragic news — usually death of a parent, child, spouse, or close friend. Some were just stressful life events — a fierce argument, being robbed, having to appear in court, a car accident, an armed robbery. A couple were even joyful — surprise reunions and parties.
Laboratory studies suggested that the emotional stress was the cause of the sudden heart weakness. Blood tests showed adrenaline levels two to three times as high as expected. Several of these patients underwent endomyocardial biopsies — a procedure in which a small chunk of heart muscle is snipped out by a special catheter. Most of these biopsies showed that the heart-muscle tissue was full of inflammation with damaged cells.
Here is how the researchers put everything together. Sudden emotional stress led to a surge in adrenaline levels, which caused blood vessels to squeeze down and reduce blood flow to the heart. Another theory is that the adrenaline directly damaged the heart-muscle cells. Similar findings have been described in patients who have had large strokes, and the heart-muscle damage in these cases is believed due to high adrenaline levels.
Now here is the good news — the patients did quite well. Their heart-muscle function quickly improved, and none have died in the four years that the Hopkins researchers have followed them.
Still, they were frighteningly ill, and might have died if they had not received excellent, immediate care. And don’t we all know stories of people who received shocking news, and died a few hours later? Does this mean we are all vulnerable to heart problems if we have sudden bad news — or even good?
Probably not. The patients in this series were older — the median age was 63 — and all but one were female. Most had high blood pressure.
An optimistic interpretation of these data is this: You can’t hide from stress and bad news. But you can exercise and try to be as physically fit as possible. Fitness lowers the amount of adrenaline your body secretes as you go through life, and this study provides a reminder that adrenaline can be bad for you. Exercise also keeps your blood vessels more limber, so that spasm may be less likely to result from a major adrenaline surge.
This syndrome is so new and so rare that no one can know for sure if exercise will reduce its likelihood, but it is clear that exercise is a good thing, and it may be the best way to stave off broken heart syndrome.
Thomas H. Lee, M.D., is the chief executive officer for Partners Community HealthCare Inc. He is a professor of medicine at Harvard Medical School. He is an internist and cardiologist at Brigham and Women's Hospital. Dr. Lee is the chairman of the Cardiovascular Measurement Assessment Panel of the National Committee for Quality Assurance.