“Broken Heart Syndrome” – An Interesting Example of when Mental Health and Physical Health Meet

“Broken Heart Syndrome” – An Interesting Example of when Mental Health and Physical Health Meet

Takotsubo cardiomyopathy, or broken heart syndrome, was first described in Japan by Sato et al. in the 1900s [1]. As a medical student, I first came across it in the same way as most medical students learn new things: on Scrubs. I joke, obviously. Well, about the first thing at least – I genuinely did learn about this on Scrubs.

As medical students, we are constantly told to keep on top of the latest developments in medicine and to look up things we don’t know about. Takotsubo cardiomyopathy, therefore, was something that I decided to look up after that episode of Scrubs. To my slight surprise, the condition was very real. Rare, yes, but very much real [1].

Note – This isn’t a scientific journal or a peer reviewed piece that I am writing. It is merely a blog post highlighting my interest in the condition.

What actually happens in Takotsubo cardiomyopathy?

In essence, the condition arises as a result of some sort of severe emotional or physical stress [2]. The result is a set of signs and symptoms that seem to be very similar to acute coronary syndromes. For the non-medical folk reading, an acute coronary syndrome essentially describes possible heart problems, including things like heart attacks.

Let’s stop and think about this for a second. Severe stress can lead to symptoms that are similar to a heart attack?! The answer is yes – but it’s important to realise that this is extremely rare. Chest pain is a symptom that can arise out of things like anxiety, and I know from experience just how horrible and scary it is. It’s important to realise, however, that having chest pains as a result of anxiety is almost certainly not Takotsubo cardiomyopathy.

So what ARE the signs and symptoms?

As a result of the sudden stress, there is a change in the shape of the left ventricle of the heart (again, for the benefit of the non-medical folks – this is essentially one of the four chambers of the heart). The shape represents something called a takotsubo – that is, a pot that Japanese fishermen use to catch octopuses [2]. The function of the left ventricle during systole is also impaired, with left ventricle ejection fraction decreasing.

The symptoms include severe chest pain (again, read above – chest pain happens in things like anxiety without someone having this), dyspnoea (shortness of breath), heart arrhythmias and cardiogenic shock [2].

The ECG can represent a STEMI – that is, an ST-elevated myocardial infarction (heart attack). I feel good typing this because an ST elevation is probably the only thing that I can identify on an ECG right now. Cardiac enzyme markers, such as troponin, can also be elevated. A high troponin can also be indicative of a heart attack. Both these signs are really quite something in my eyes – we’re talking clinical signs that can also be seen in heart attacks.

Prognosis

(Prognosis is a fancy term for ‘outcome’)

Thankfully, it appears as though in most cases, the condition is very much treatable and has a good prognosis. Costin G et al. do note, however, that it is difficult to be certain about the possibility of relapse, as there is poor follow up following treatment [2].

Why did this interest me?

It is no secret that mental health is something that interest me greatly. My own experiences of severe depression at medical school is what sparked this interest, and is what has made me start thinking about psychiatry as a profession. It’s therefore not very surprising that I decided to look this up. Oh, and I do like looking up conditions that I’ve not heard of in general, be it for physical or mental health conditions.

Going back to the mental health aspect, let me expand slightly. It is no secret that mental health conditions can present with physical health symptoms. The NHS website itself has a list of physical symptoms that can appear in someone with clinical depression [3].

In this case, the physical symptoms experienced as a result of some psychological shock are…extreme, to say the least. It does nicely highlight, however, that – much to the denial of some people – the symptoms of mental health problems are very much real. Not only real, but they can appear to be rather severe too.

Final thoughts

I have reiterated it a few times but I will do so again – Takotsubo cardiomyopathy is EXTREMELY rare, to the point that it got mentioned on Scrubs to make the show a little interesting. If you are experiencing things like chest pains or shortness of breath, it is highly unlikely to be this. It is best to go and speak to your doctor for advice in such conditions rather than self-diagnosing.

If you do experience severe, sudden onset, life-threatening chest pain, please call 999 or the emergency services near you.

Thedepressedmedstudent.

References

[1] Merchent E et al. Takotsubo Cardiomyopathy: A Case Series and Review of the Literature. The Western Journal of Emergency Medicine. 2008; 9(2). 104 – 111.

[2] Costin G et al. A Psychosomatic Perspective on Takotsubo Cardiomyopathy: A Case Report. The Primary Care Companion for CNS Disorders. 2011; 13(2). [Accessed online] Available from: doi:  10.4088/PCC.10br00980whi

[3] NHS. Symptoms of Clinical Depression. Available from: http://www.nhs.uk/Conditions/Depression/Pages/Symptoms.aspx [accessed 10th May 2017]

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