Feb 12 2005
A study published in this week's issue of the New England Journal of Medicine has found that sudden emotional stress can trigger a severe but reversible heart muscle weakness that mimics a heart attack. The condition had been labeled "stress cardiomyopathy" and has also been called "broken heart syndrome." The culprit appears to be adrenaline and similar "stress hormones" that over-stimulate the nervous system.
The study's lead author, Ilan Wittstein, M.D., is quoted by Newswise: "Our study should help physicians distinguish between stress cardiomyopathy and heart attacks, and it should also reassure patients that they have not had permanent heart damage." It is particularly important that doctors make this distinction, since the treatment of stress cardiomyopathy and heart attack are different.
We all respond to stress differently. Some people respond by releasing large amounts of adrenalin and similar "catecholamines" into the bloodstream. These chemicals are part of the fight-or-flight response that makes us faster and stronger under stress. For people with this particular response, sudden and overwhelming stress releases such a flood of these chemicals that the heart muscle is stunned. Patients typically feel chest pain and shortness of breath.
Wittstein is quoted as saying that "after observing several cases of "broken heart syndrome" at Hopkins hospitals - most of them in middle-aged or elderly women - we realized that these patients had clinical features quite different from typical cases of heart attack, and that something very different was happening. These cases were, initially, difficult to explain because most of the patients were previously healthy and had few risk factors for heart disease."
In the recent study the researchers found that initial levels of catecholamines in the stress cardiomyopathy patients were two to three times the levels among patients who had had a classic heart attack (and 7 to 34 times normal levels). Other stress hormones were also elevated, and heart biopsies also showed an injury pattern consistent with a high catecholamine state and not heart attack.
We still don't know how these chemicals stun the heart, but this study should help improve the treatment of patients with chest pain and heart attack symptoms. It also helps us understand even more about the complex relationships between the mind and body.
Last updated 11/5/05
