U.S.|Sudden Stress Breaks Hearts, a Report Says
Sudden Stress Breaks Hearts, a Report Says
By Denise Grady
Sudden emotional stress -- from grief, fear, anger or shock -- can cause heart failure, in a little known and poorly understood syndrome that seems to affect primarily women, researchers are reporting today. The victims are generally healthy, with no history of heart disease.
A death in the family, an armed robbery, a car accident, a biopsy procedure and a surprise party were among the events that sent 18 women and one man to coronary care units in Baltimore with chest pains and weakening of the heart, according to an article in The New England Journal of Medicine.
Most were older: their median age was 63. But one was 27, another 32. Some had such poor heart function that they would have died without aggressive treatment to keep their blood circulating, the researchers said. But all recovered.
The cases were described by doctors from Johns Hopkins University who treated the patients from 1999 to 2003.
The new research on the condition, nicknamed broken heart syndrome by the doctors, suggests there may be some truth to the old idea that people can be scared to death or die from sorrow like characters in a romantic novel or a country song.
"It's important for people to know that this is something that emotional stress truly can do," said Dr. Ilan S. Wittstein, a cardiologist at Johns Hopkins University School of Medicine and the lead author of the article.
"How exactly it occurs is not clear, but the patients had unusually high levels of stress-related brain chemicals and hormones like adrenaline, which may have temporarily impaired their heart function. Why nearly all the victims were female is also unknown.
The researchers' scientific name for the condition is stress cardiomyopathy. It is not a heart attack, though it may be mistaken for one. The patients recovered fully and, unlike heart attack victims, did not suffer lasting damage to the heart muscle.
The researchers say it is important to distinguish the syndrome from a heart attack so that people can be treated properly and reassured that their hearts are healthy, rather than being told they have coronary disease and need to be on heart medicine for the rest of their lives. A mistaken diagnosis of heart attack may also make it harder for a person to get life or health insurance.
Heart attacks occur when a blood clot in a coronary artery cuts off circulation to the heart muscle, which may then die. Emotional stress can bring on a heart attack in someone who has coronary disease.
But with stress-induced heart failure, patients do not have blood clots, diseased arteries or patches of dead heart muscle. They have a weakening of the heart that decreases its ability to pump, but it is temporary.
"The prognosis seems to be excellent," Dr. Wittstein said. "It is incredibly important not to be sent out thinking you've had a massive heart attack. Doctors and patients should both know that."
How often the condition occurs is not known. But the severity seems to range from mild to deadly. Some people may feel a bit ill for a short time and never see a doctor, but others may die if not treated, he said.
"The only thing making it not a common problem is the inability to recognize it," Dr. Wittstein said, adding that he expected the number of cases to rise as word got out and doctors learned how to diagnose the syndrome. When he gives talks about it at conferences, doctors often approach him later and say, "You know, I think I saw a case like that," he said.
But some cardiologists remain skeptical about the condition, he said.
"Will it turn out to be as common as a conventional heart attack?" Dr. Wittstein asked. "Of course not."
He said he and his colleagues saw about half a dozen cases a year. "But they seem to come in waves," he said. "We had three in the past 10 days."
One of the earlier patients, he said, was a 60-year-old woman whose family had given a surprise birthday party for her.
"Seventy people jumped out from the dark and screamed, 'Surprise!' and literally three hours later she was in the intensive care unit," Dr. Wittstein said.
Another patient was Sharon Lawson, a retired social worker in Havre de Grace, Md. Two years ago, Mrs. Lawson, then 61, was having a lung biopsy to determine whether cancer had spread from a kidney tumor treated in 1991. Her daughter was to be married a few months later, and Mrs. Lawson's main worry was that she would be unable to attend the wedding or help plan it.
"I dearly wanted to be around for that," she said. Lying on the table, she prayed. Then she felt herself fainting and called out to the doctors. The next thing she knew, she said, "I was being rolled down a hallway, running."
Her heart was pumping so weakly that doctors concluded the only way to save her life was to thread a device called a balloon pump through blood vessels into her aorta to help circulate her blood. She was also put on a respirator.
She was well enough to go home within two days, and three weeks later her heart function was normal.
Several other cardiologists not connected with the study said in interviews that they had also seen patients like the ones Dr. Wittstein described. Dr. Valentin Fuster, director of the cardiovascular institute at the Mount Sinai School of Medicine in Manhattan, said he had had three such patients and added: "The important thing is the prognosis. It is reasonably good."
Dr. Maryjane Farr, director of the heart failure program at the Weill Cornell Center of New York-Presbyterian Hospital, said doctors at her hospital had also seen similar cases, almost entirely in women, and had a conference about them yesterday, before they even knew about Dr. Wittstein's article.
"In an observational way, people agree with the concept," Dr. Farr said.
Another cardiologist, Dr. Deborah Davis Ascheim, of the heart failure center at Columbia University Medical Center of New York-Presbyterian, said, said the theory deserved more study. "It's intriguing, but I don't buy it," she said.
The doctors at Johns Hopkins and Dr. Fuster said they thought the syndrome occurred because the huge burst of adrenaline in these patients was toxic to the heart muscle and "stunned" it, leaving it temporarily unable to contract. The Hopkins researchers measured adrenaline and related stress hormones in 13 patients with the syndrome and found the levels to be 2 to 3 times those in people having severe heart attacks, and 7 to 34 times normal levels.
Scientists have known for decades that the body pours out adrenaline under stress in the "fight or flight" response, which speeds the heart rate and tenses the muscles to get a person ready to fight or run from a threat. But in some people, for unknown reasons, the rush of adrenaline may be more than the heart can take.
Dr. Wittstein said that so far none of the patients described in the article had had repeat episodes but that it was impossible to predict whether they would. He said Japanese researchers had been tracking similar patients for 10 years and had reported no recurrences.
Another cardiologist involved in the study, Dr. Hunter Champion, said the team had treated one patient who was distraught on the anniversary of her husband's death. It was the first time they had seen her, but she told them she had been hospitalized on two previous anniversaries, and they wondered if she might have had the same condition several times.