Sudden shock can lead to heart attack

Emotional shock really can lead to a broken heart. A study at Johns Hopkins University School of Medicine has demonstrated that sudden emotional stress can result in reversible heart failure.

This condition mimics the classic heart attack according to Hopkins cardiologist and lead author of a recent study Dr. Ilan Wittstein. His research findings have been published in the New England Journal of Medicine. In a study of 19 cases of "broken heart syndrome" between 1999 and 2003, the researchers demonstrated a link between intense emotional stress and cardiac failure in otherwise healthy individuals.

Often, what triggers a heart "break" is an incident far more traumatic than a minor disappointment. Rather, a traumatic event such as a breakup, the death of a loved one, or even the shock of a surprise party can provoke a heart attack in people who don't have heart disease and are otherwise healthy, researchers say. It may only require short-term treatment because the heart usually recovers by itself.

"It's important for people to know that this is something that emotional stress truly can do," Dr. Ilan Wittstein told New York Times reporter Denise Grady. He told Washington Post reporter Rob Stein that, "A broken heart can kill you, and this may be one way." Doctors believe these heart attacks happen more often than they realize because they normally mistake them for an attack related to poor health, not emotional trauma.

In this case, an excess of stress hormones rather than clogged arteries is the cause of severe heart muscle weakness. Doctors refer to this condition as stress cardiomyopathy, although it is more commonly referred to as the "broken heart" syndrome. The heart simply weakens, making it temporarily less able to pump blood.

This condition is often misdiagnosed as a massive heart attack. Dr. Wittstein stated that the "study should help physicians distinguish between stress cardiomyopathy and heart attacks." Dr. Wittstein said being able to recognize broken heart syndrome in patients has helped his team avoid "incredibly invasive procedures." Dr. Wittstein told Grady, "The prognosis seems to be excellent. It is incredibly important not to be sent out thinking you've had a massive heart attack. Doctors and patients should both know that." As doctors become more aware of the phenomenon, they can take steps to avoid long-term damage and at least mend the physical aspects of a "broken heart."

Dr. Wittstein and his research team found that some people may respond to sudden, overwhelming emotional stress by releasing large amounts of adrenalin and other chemicals into the blood stream. These chemicals can be temporarily toxic to the heart, effectively stunning the muscle and producing symptoms similar to those of a typical heart attack: chest pain, fluid in the lungs, shortness of breath and heart failure. However, there are no further similarities between "broken heart" syndrome and cardiac arrest. Closer inspection using blood tests and magnetic resonance imaging scans failed to show the typical heart attack signs, such as irreversible muscle damage and elevated levels of certain enzymes.

In the cases studied, most with the condition were elderly, with median age of 63. However, one victim was 27 and another 32. Some had such poor heart functioning that they would have died without aggressive treatment to keep their blood circulating, the researchers said. But all recovered.

Wittstein cautioned that even a stress-induced heart attack must not go untreated. There may be underlying heart disease that must be addressed and the symptoms of broken heart syndrome, if severe enough, must be dealt with quickly.

Interestingly, stress cardiomyopathy is more common in women. It is thought that this may be due to differences between men and women in their reactions to stress, particularly emotional stress.