[tri-med] FYI - Broken Heart Syndrome

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believe it may be of interest and is from a reliable source. As always,
check the information with your own doctor or health care professional
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Broken Heart Syndrome
March 16, 2005

By Thomas H. Lee, M.D.
Brigham and Women's Hospital 

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. 

                  Building ___ooOOoo__ Rainbows
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