broken heart syndrome is that even a real thing in 2019 a 65 year old italian woman went to her local
dentist to get a tooth taken out it was supposed to be a minor oral surgery she didn't even need
to be put under just local anesthesia around the tooth and it just gets plucked out no big deal right
except for the fact that she fainted right after the dentist numbed her up maybe the dentist
assumed it was just because she wasn't good with needles but it quickly became clear that something
much more serious was happening because she soon went into cardiac arrest and as emts frantically
attempted to revive her the most urgent questions became what was happening to her and why but this
was no heart attack this was something different harder to spot but more difficult to diagnose but
equally as dangerous this was a real case of broken heart syndrome so let's break down the
history of this strange medical condition that had plagued the last seven years of this woman's life
broken heart syndrome is a medical mystery that let's be real sounds kind of fake in addition to
tracing the story of our italian dental patient we're going to discuss how broken heart syndrome
was discovered and what it looks like and who is at risk buckle up because this may be one of the
most unusual and fascinating health conditions to be discovered in the last you know what let's do a
pop quiz when do you think broken heart syndrome was first discovered was it a 1892 b 1947 c 1991
or d 2005. if you said c or d you'd technically be right ish but we'll get to that for now let's
say that our first correct answer is d 2005. this syndrome has only been officially recognized by
the english-speaking medical establishment since 2005 the year of hurricane katrina a new catholic
pope and the creation of this very platform youtube even though shakespeare dickinson and
billy ray cyrus have been harping on the pain of unrequited love for centuries the first reported
cases of medical achy breaky heart were only validated in the english-speaking world when
dr elan whitstein published a paper on the condition in the new england journal of medicine in 2005.
of course just like the video game consoles in public transportation the japanese had done it before us
and better that's why you'd be correct if you said c all the way back in 1991 a team of
japanese researchers published a series of papers documenting their observations of the syndrome
they discovered it they got to name it which is why it's officially known as
takotsubo cardiomyopathy obviously broken heart syndrome is a bit more catchy in english but
the reason for this original name is based on a cleverly hidden secret about the condition itself
takotsubo cardiomyopathy let's break it down we'll start with the second word cardiomyopathy now you
may have heard doctors on medical shows rattle this one off if we break it up cardio means heart
myo means muscle pathy means disease these are all from greek roots doctors love greek
roots so put them all together and cardiomyopathy refers to a disease that affects the heart muscle
and subsequently its ability to pump blood to the rest of the body this happens when
the heart muscle becomes weakened from stiffening or scarring or both so then what's the first word
about takotsubo because that's where the secret lies real quick anatomy 101 your heart it's got
four chambers divided into left and right atrium and left and right ventricles separating them our
valves what you need to know is that the biggest chamber the left ventricle is responsible for
pumping oxygen-rich blood past the aortic valve and it delivers all that blood to your organs
well except for your lungs because that's pumped by the right ventricle but notice the shape of
the left ventricle what does that shape look like to you an arrowhead a leech an organ used
for reproduction i don't know but this is how it's supposed to look here comes your fun fact takotsubo
in japanese breaks down into taco meaning octopus suba meaning pop huh takotsubo actually isn't a
medical term it's a type of pot that's used by japanese fishermen when japanese doctors first
observed this condition they took one look at that left ventricle and they said hey that looks like
one of those pots that catches octopuses or is it octopi i don't know but that's what it looks like
it causes the left ventricle to swell up like a balloon down below with a narrow neck above which
takes us back to our 65 year old italian woman how do we know that she was suffering from this seven
years before she'd been admitted into a hospital with symptoms of chest pain and fainting and at
that time her echocardiogram meaning ultrasound of the heart revealed that her left ventricle wasn't
pumping so well and it also showed that the left ventricle was ballooning down below with a narrow
neck now to compare this echocardiogram image to our heart drawing we'll have to flip it upside
down look at that classic takotsubo cardiomyopathy she recovered fully within a couple of weeks but
a year later she's back in the hospital with the same scans same results and ultimately the
same recovery and then she has a third episode which maybe you think she's just gonna have a
repeat of the same thing all over again right but hold on a second why does this happen to
the left ventricle and why did our italian woman suffer from broken heart syndrome in the dentist's
office of all places as you might have guessed from the name researchers originally theorized
that a big emotional shock was the precursor to this condition a lot of circumstantial evidence
supported that theory so back in 2004 for example there was a huge earthquake that rocked central
japan and in the months that followed no fewer than 16 people were diagnosed with this condition
and that makes sense a bunch of people lose their homes in a traumatic natural disaster that's
hugely stressful other researchers reported seeing broken heart syndrome in patients who had recently
lost a loved one another patient was panicking because of gambling losses another because of the
stress of their job in fact grief fear anger and even surprise have all been reported as
precipitating episodes of broken heart syndrome so at risk of downplaying the seriousness of this
condition i have to say some of the triggers for broken heart syndrome are kind of wild which of
the following is an actual reported trigger of broken heart syndrome a winning the lottery
b unexpectedly asked to give a speech at work c a beloved pet labradoodle being threatened while on
a walk d trying to apply hair dye while camping your tent blowing away being forced to go grab
the tent and re-spike it all the while stressing out about what color your hair is going to end up
since you've had the dye in your hair for too long this is a trick question because the answer is
e all the above yep so did our italian dental patients suffer from a recent loss was her heart
literally broken we don't know the cause of our first two episodes of broken heart syndrome but in
the case of our third episode it doesn't appear to have been an emotional trigger more recent
research has revealed that statistically physical triggers cause a higher percentage of cases than
emotional ones so a multi-year study that was published in the new england journal medicine
found that physical triggers like an accident a broken bone head trauma major health complications
like pneumonia or drug withdrawal and surgery are present in one third of cases which is about the
same number for emotional triggers as the cause also about one-third of cases have no apparent
trigger at all and this is a diagnosis that can be pretty tricky to pick up on chest pain nausea
fainting those symptoms can occur with a much more common diagnosis a heart attack or myocardial
infarction but while a heart attack involves blood vessels in your heart getting blocked by plaque
buildup this is entirely different and just as the italian woman had done twice before when she was
hospitalized for those symptoms doctors need to image your heart by performing an echocardiogram
coronary angiography or mri to make the distinction but who is actually more likely to get
this syndrome in a survey of over 1700 patients with broken heart syndrome nearly 90 percent were women
women are nine times more likely than men age is another big factor the average age being 67
patients with broken heart syndrome were twice as likely to have been diagnosed with a neurologic
or psychiatric disorder yeah over half of patients had a history of mental issues which was what
happened with this lady at the time of her dental appointment she was taking benzodiazepines for an
anxiety disorder but even if you fall into all of these demographics that doesn't necessarily mean
that you'll get it so just how common is it well between 2006 and 2017 there were slightly under
140 000 cases of this that were reported in the united states that's about 13 000 cases per year
but keep in mind that increasing awareness of this condition means that the number of cases diagnosed
every year is also increasing and because broken heart syndrome is so hard to distinguish
from a heart attack a lot of these cases still go misdiagnosed whether as it's being diagnosed as
acute coronary syndrome such as a heart attack or sometimes it could be diagnosed as a simple panic attack
in fact doctors think that two percent of acute coronary syndrome diagnoses may actually
be broken heart syndrome that may not sound like a lot but with 16 million people in the us alone
diagnosed with various heart conditions every year that's an estimated 320 000 people being
misdiagnosed on an annual basis for a long time broken heart syndrome appeared relatively benign
a large majority of patients do recover within two to four weeks and the left ventricle goes
back to its non-octopus pot shape but what do you think the short-term mortality rate is for someone
experiencing an episode of this condition is it a one to two percent b three to five percent
c ten percent or d eighteen percent the answer is b three to five percent but c and d are relevant for
us as well because while immediate death rates are under 1 in 20 wait just one year after an initial
diagnosis of broken heart syndrome and mortality rates are much higher one study found that
mortality rates after a year were 10 for female patients while men were all the way up to 18
these are comparable to mortality rates for heart attacks worldwide broken heart syndrome
deaths may be as high as 40 000 per year in this case her third episode of broken heart syndrome
brought on by the stress of getting a minor dental surgery led to her going into cardiac arrest and
she died not long after in autopsy revealed that there was no coronary artery disease
or valvular disease no heart attack but it did show extremely unusual apical ventricular
ballooning and there's your diagnosis but how does broken heart syndrome develop in the first place
medical theories should always start with the medical facts we know women are nine times more
likely to get it than men and far more likely to develop it when they're older than age 55.
around age 50 menopause hits in the production of estrogen starts declining estrogen is a
hormone that regulates a lot of stuff including protecting the heart from the harmful effects of
norepinephrine aka adrenaline when we get super stressed out we enter this fight-or-flight mode
and the body releases catecholamines these hormones epinephrine and norepinephrine
can wreak havoc on the body think about what would happen if you go for a walk and all of a sudden
you see a huge bear walking toward you your fight or flight mode kicks in your heart is pumping
harder and faster because of these hormones and sometimes these hormones whip the heart so much
it ends up overworked and it weakens also anxiety and depression likely plays a role in this as well
so estrogen also influences the production of neurotransmitters like norepinephrine
serotonin dopamine and low levels of certain neurotransmitters are associated with depression
but there is still a lot we don't know this research is still in its early stages and weirdly
enough one of the drugs most often given to reduce the effects of adrenaline that would be beta
blockers like metoprolol appears to have no effect on mortality rates when given to people with
broken heart syndrome we know that you can die of broken heart syndrome although it's unlikely but
we still don't know quite why but at least you now know the japanese word for an octopus catching pot