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The Broken Heart Syndrome

The Broken Heart Syndrome. Primary Care Conference May 30, 2007 Gregory L. Sheehy, M.D. Case Report. AC is a 64 year old woman History of right breast cancer, 1990 s/p mastectomy, chemotherapy and radiation) complicated by recurrent RUE lymphedema/lymphangitis. Type 2 DM HTN

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The Broken Heart Syndrome

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  1. The Broken Heart Syndrome Primary Care Conference May 30, 2007 Gregory L. Sheehy, M.D.

  2. Case Report • AC is a 64 year old woman • History of right breast cancer, 1990 • s/p mastectomy, chemotherapy and radiation) complicated by recurrent RUE lymphedema/lymphangitis. • Type 2 DM • HTN • Uric acid nephropathy • Obesity

  3. Case Report-Medications • Glyburide 1.25 mg daily • Metformin 1000 mg bid • Phenoxymethyl penicillin 1000 mg bid • Lisinopril 10/HCTZ 12.5 mg daily • Metoprolol XL 100 mg daily • Gemfibrozil 600 mg bid • Aspirin 81 mg daily • Allopurinol 300 mg daily

  4. Case report-May 26, 2006 • Because of risk factors (age, hypercholesterolemia, hypertension, diabetes, family history) a radionucleotide stress test was performed and was negative

  5. Case report-December 14, 2006 • AC calls office, speaks with triage nurse • Patient is reported to be hysterical, crying, sobbing and begging for a sedative • Her 35 year old son was just found dead in bed • Alprazolam 0.25 mg 1-2 tablets q 8hrs prn called to local pharmacy

  6. Case report- December 15, 2006 • AC awakes from sleep early morning hours with right chest pain • She then develops dyspnea, diaphoresis, lightheadedness • EMS called • On paramedic arrival, patient in acute distress, SBP 70s • Patient transferred to UW ER, vital signs similar, IVF and dopamine initiated

  7. Case report-data • Electrocardiogram revealed mild ST elevation in lateral leads (see copy) • Initial troponin 1.5 (<0.3) with peak of 4.4 approximately 20 hours later • Echocardiogram showed “mild to moderate” reduction in systolic function with a an ejection fraction of 40% and an akinetic apex • Emergency cardiac cath demonstrated diffuse nonocclusive coronary artery disease • Near complete recovery in 48-72 hours

  8. What is “The Broken Heart Syndrome”? • Other names: • Stress induced cardiomyopathy • Transient apical ballooning • Takotsubo Cardiomyopathy • A definition: • “Transient apical left ventricular dysfunction that mimics myocardial infarction, but in the absence of significant coronary artery disease.” UpToDate, 2007

  9. Broken Heart Syndrome • First described in Japan… “Takotsubo” is an octopus trap (see diagram)1 • More common in women than men • Onset typically triggered by an acute medical illness or intense emotional/physical stress (death in the family, domestic abuse, financial catastrophy, natural disaster) 1). Tsuchihashi K et al, J Am Coll Cardiol 2001; 38(1): 11-8

  10. Broken Heart Syndrome • Pathogenesis…still uncertain • Catecholamine excess1 • Coronary artery spasm • Myocardial stunning • “Aborted myocardial infarction” (transient thrombosis and dissolution)2 1).Wittstein et al, NEJM 2005; 352(6): 539-48. 2). Ibanez et al, Mayo Clinic Proceedings, 2006; 81(6): 732-35.

  11. Broken Heart Syndrome • Is this syndrome more common than we realize?1 • The good news- recovery is relatively rapid and complete 1). Park et al. Stress Induced Cardiomyopathy in an ICU, Chest 2005; 128: 296.

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