broken hearts

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don't break my heart

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Heartbroken is just a word we use but did you know that hearts could really be broken? Till recently, even doctors did not take broken hearts seriously.

Around ten years ago, there were a few high profile deaths in young people. They were diagnosed as having died from a "broken heart". Now, a broken heart or stunned myocardium syndrome (also called takotsubo) is a documented condition. It occurs as the response of the heart to sudden, intense emotional stress such as the death of a spouse; rejection at the workplace; acute fear; or uncontrolled anger. These intense emotions can cause immediate breathlessness or strokes. The broken heart can occur simultaneously or a few minutes later.

The sudden surge of uncontrolled emotions causes the release of two chemicals, adrenaline and nor adrenaline. These help the body ready itself for a "fight or flight" reaction. Sometimes, there is an abnormal elevation of these chemicals. This causes the cardiac arteries to narrow, decreasing blood flow to the heart. The adrenaline binds to the heart muscles, causing a large number of calcium ions to enter the cells and skewing the balance among calcium, potassium and sodium. The muscle becomes dysfunctional. The affected areas start to balloon out. The lower-most part of the heart (the apex) has the least blood supply so it is most affected.

The symptoms are similar to a heart attack - chest pain, sweating, giddiness or dizziness, nausea, vomiting, weakness and palpitations. Blood pressure may drop. Heart failure may develop.

The ECG changes are atypical, with imprecise changes in the ST segment and T waves. They are "suspicious of but non conclusive" of myocardial infraction. Blood tests for the enzyme creatine kinase and proteins troponin should be done. These are elevated in a heart attack. In a stunned heart, these results too are inconclusive. The echocardiogram is the clincher. The heart is ballooned out. This change occurs typically at the apex of the heart. It is important to make a distinction between heart attack and takotsubo as the medication is different.

The treatment for takotsubo is mainly supportive. Medication is given to remove fluid from the lungs and prevent clots. Recovery occurs within a few days.

About two per cent of people who were thought to have a heart attack actually had broken hearts. In the case of women, this increases to seven per cent. Women, mainly menopausal ones (60-75 years), have "broken hearts" eight to nine times more often than men. Some people are genetically prone to "broken hearts." Depression plays a role in susceptibility to this condition. Recurrences can occur in 10 per cent of people.

People who are in poor physical condition do not need severe emotional stress to suffer a broken heart. An episode may be precipitated by a minor event like rejection, or even a lecture or talk before an audience.

In order to never develop this condition; it is important to develop metal and physical toughness. Walking for 40-60 minutes a day at a brisk pace exposes the heart to small doses of adrenaline and nor adrenaline in a controlled manner. The heart gets conditioned and is immune to sudden chemical surges. Meditation and yoga provide calmness and the mental strength to cope with good days and bad.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in