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broken-heart-syndrome

‘Broken Heart Syndrome’ Seen Rising with Pandemic

It seems the novel coronavirus possesses an endless arsenal of methods to impact humans. In addition to the physical consequences of contracting the virus, the stress everyone is feeling these days is manifesting in unforeseen ways, including one our family practice doctors have recently learned about.

It’s a phenomenon known as “broken heart syndrome,” and a new study suggests that the stress associated with COVID-19 is causing additional wear and tear on the cardiovascular systems of many of those who haven’t even been infected with the virus.

The study, released earlier this month in the journal JAMA Network Open, found that the syndrome, which is typically found in women over the age of 70, has been showing up in younger patients who have been hospitalized since this spring for suspected heart attacks.

 

What is “broken heart syndrome?”

The condition was identified in Japan over 25 years ago, but many Americans first became familiar with it when actress Carrie Fisher died three years ago. Her mother, Debbie Reynolds, took it especially hard, dying the day after her daughter’s death, reportedly of a stroke.

Reynolds’ son Todd Fisher said that his mother’s last words were, “I just want to be with Carrie.”

Studies have shown that heart attacks and strokes increase at higher-than-expected rates in the month following the death of a loved one, and peak over the following year. According to the Journal of the American Heart Association (JAMA), a person’s risk of having a heart attack increases by 21 times in the first 24 hours after losing a loved one.

But any type of sudden or prolonged stress can trigger “broken heart syndrome.” The medical term is “stress-induced cardiomyopathy.” The symptoms are the same as a true heart attack, and even show up in blood tests and on the EKG as a heart attack.

The difference between the two is in the arteries—open during stress-induced cardiomyopathy, blocked during a classic heart attack—and the fact that stress-induced damage to the heart can be more extensive than the more localized damage commonly seen in the classic heart attack.

In addition, if you survive the damage from stress-induced cardiomyopathy, the heart will soon return to normal, unlike what happens during a classic heart attack.

 

Stress and the heart

Although the term “broken-heart syndrome” is most often associated with the loss of a loved one, any kind of sudden shock, physical stress or anxiety can induce chest pain, shortness of breath, sweating, left-arm pain and so on that usually indicates a heart attack.

What happens in the stress-induced attack is an abrupt swelling of the left ventricle, brought on by the sudden release of large amounts of dopamine, adrenaline and norepinephrine. This can cause the heart to malfunction, and even create blood clots which—as is thought to have happened to Reynolds—can then travel to the brain and cause a stroke.

A related syndrome, often more deadly than broken-heart syndrome, is the long-term effect of stress on the body. Typically, those who experience prolonged stress are not only flooded with cortisol and other stress hormones, but the accompanying emotions cause them to eat poorly, neglect exercise, become socially isolated and suffer from insomnia, all known to suppress the immune system and impact heart health, as well.

 

The coronavirus study

While some have questioned the relatively small size of the recent Cleveland Clinic study, its lead researcher, Ankur Kalra, an Akron General cardiologist, said that he and his colleagues had already noted an increase in stress-induced cardiomyopathy as early as late March.

This provoked the question, “Is the virus causing this, or is it the stress from the virus causing this?” Kalra explained. Because all patients in the study tested negative for COVID-19, they concluded it was the latter.

The researchers looked at 1,914 acute coronary syndrome patients at two hospitals in the Ohio area who underwent coronary arteriography, in which dye is injected to track blood flow through the arteries. When they compared the results with similar patients hospitalized two years earlier, they found a significant increase in “broken heart syndrome” dating from the beginning of the pandemic.

Not only were the numbers much higher—7.8 percent during the pandemic vs. 1.8 percent previously—the patients also had longer hospital stays than those prior years. They did not find an increase in deaths, however, possibly because the average age of the patients was 63. Ninety percent of those who typically experience broken-heart syndrome are women over 70.

 

Be aware of the risk

Both Kalra and the study’s lead author, Dr. Grant Reed, stressed the importance of self care to minimize the stress that everyone is feeling during the pandemic.

“Exercise, meditation, and connecting with family and friends, while maintaining physical distance and safety measures, can . . . help relieve anxiety,” said Reed, who is also director of Cleveland Clinic’s STEMI (ST-elevation myocardial infarction) program.

 

Meanwhile, if you are experiencing any unusual heart-related symptoms, call 911.

If you are subject to unusual anxiety, grief, or despair, whether or not it’s related to the pandemic, call us. It’s important to realize the impact stress can wreak on the body, and we can offer suggestions on ways to cope.

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