Dear Doctor: I've heard that people can die from a broken heart. Is that really possible?
Dear Reader: We think you're referring to a condition known as "broken-heart syndrome," which has been in the news recently thanks to the unique backstory of an otherwise technical and wonky article published in The New England Journal of Medicine. The scientific name for broken-heart syndrome is "Takotsubo cardiomyopathy," also referred to as stress cardiomyopathy. Most people who experience broken-heart syndrome will recover. In some rare cases, though, it can lead to death.
The article that got so much attention examined the case of a 61-year-old woman in Texas who, upon waking up one morning, had such bad chest pain that she went to her local emergency room. Because her symptoms seemed to indicate a heart attack, she was promptly airlifted to a cardiac care hospital in Houston. However, a series of medical tests there took an unusual turn.
Although the woman's blood chemistry findings and altered heart rhythms were consistent with a heart attack due to coronary artery disease, doctors were startled by the scans of the woman's heart. Unlike in a heart attack, in which the heart muscle is starved of oxygen due to blockages in the major arteries, this woman's arteries were clear. What further tests did suggest was a classic case of Takotsubo cardiomyopathy.
The patient's left ventricle, the main pumping chamber of the heart that sends blood throughout the body, had stopped working properly. Instead of working at 100 percent capacity, the blood flow from the left ventricle was significantly compromised. The precise reasons for this phenomenon aren't yet known. Researchers suspect that a combination of stress hormones released during a particularly difficult physical or emotional incident stun the heart and alter its function.
The truth is the condition isn't all that rare. Up to 2 percent of the 735,000 Americans who have a heart attack each year go on to get a diagnosis of stress cardiomyopathy. The vast majority are women over the age of 50. The thinking is that after menopause, vanishing protection offered by estrogen leaves women more susceptible to this type of heart condition.
While taking the Texas woman's medical history, the hospital team learned what had pushed her into an emergency situation. Already worried about her son's upcoming back surgery and a son-in-law's recent job loss, the woman was left inconsolable after the death of one of her closest companions, her Yorkshire terrier. She and her husband considered the little dog to be a family member. When the Yorkie passed away, it broke her heart.
Once the diagnosis was made, the path to appropriate treatment became clear. Doctors put the woman on a medication called an ACE inhibitor, which widens the blood vessels. They also prescribed a beta-blocker to address her high blood pressure. A month later, tests showed significant improvement. And the very good news is that, a year later, the woman's symptoms have not returned.
(Send your questions to firstname.lastname@example.org, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)