In the last few years, researchers at Brown University, Johns Hopkins University, and elsewhere have begun keeping track of people whose hearts have stopped - or almost stopped - after intense emotional or physical stress, a problem Japanese researchers began noticing in the 1990s.
In America, it's called "broken heart syndrome" or "stress cardiomyopathy." In Japan, it's "Takotsubo cardiomyopathy." That's because "takotsubo" is the name of a pot used to trap octopus, and in these cases, the heart walls squeeze together abnormally, taking on the shape of this pot.
"The heart muscle becomes weak after sudden stress," said Dr. Ilan Wittstein, a cardiologist at Johns Hopkins, probably because of the sudden flood of stress hormones - adrenalin and noradrenalin - causing the heart to become "stunned . . the heart is unprepared for the large surge of adrenalin."
In rare cases, broken heart syndrome can be fatal, said Dr. Richard Regnante, a cardiologist at Brown University.
But if a patient makes it through the first 48 hours - often in the intensive care unit - prognosis is excellent, with complete recovery of heart muscle function in two to three weeks, said Wittstein.
The key, for doctors, is to figure out whether a person who has just suffered a terrible stress - like suddenly losing a loved one or having a major medical trauma like a stroke or a severe flare-up of asthma or even major surgery - is having a heart attack or stress cardiomyopathy. Once doctors know to look for them, the differences are clear. In a heart attack, heart muscle cells are permanently killed. Heart attack patients also typically have blockages in the arteries supplying the heart; people with broken heart syndrome - the vast majority of whom are postmenopausal women - do not.
No one knows why postmenopausal women are at greater risk. But it could be because men who have severe emotional or physical stress may actually have real heart attacks under those circumstances.
So, if you have had a severe emotional or physical shock and then develop chest pain, shortness of breath, lightheadedness, and low blood pressure, call 911 and get to the hospital immediately. Ninety-nine percent of the time, a real heart attack is probably in progress. Even if it's "only" broken heart syndrome, immediate treatment is necessary.
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