Anne Valk1
1BSc Biomedical Sciences, Radboud university medical center, Nijmegen, The Netherlands
The 14th of February. The restaurants are fully booked for romantic candle light dinners, loving couples give each other sweet presents, and some daredevils even send roses to someone they have a secret crush on. Valentine’s day: a day to celebrate love and romance. At least, for some of us. For others it is the perfect day to stay inside under a blanket with a big tub of Ben & Jerry’s ice cream. Maybe those people just do not like Valentine’s day, they do not have a partner to celebrate it with, or worse… They have a broken heart.
The broken heart syndrome, or Takotsubo syndrome, is an acute and reversible cardiomyopathy that was first described by Hikaru Sato in 1990 [1]. In the past decades, it has been increasingly reported, and interest in this syndrome has been gained among cardiologists [2]. The broken heart syndrome is characterised by left ventricular dysfunction, and the most common symptoms are chest pain, dyspnoea, and/or dizziness [3]. As the syndrome was discovered quite recently, various diagnostic criteria have been suggested, of which the Heart Failure Association diagnostic criteria are the most commonly used [2, 3]. Those criteria include transient abnormal movement of the ventricle’s wall, newly emerged electrocardiogram abnormalities, but absence of or only minor coronary artery disease [2].
You might already have noticed that the broken heart syndrome shows quite some overlap with acute myocarditis, such as its clinical presentation with chest pain and dyspnoea. However, the broken heart syndrome should be recognised as a unique type of heart failure. First of all, there are differences in cardiac biomarkers such as troponin, C-reactive protein, and serum natriuretic peptide [2]. The troponin peak, for example, is generally higher in acute myocarditis than in the broken heart syndrome [2]. In addition, electrocardiography, echocardiography, and magnetic resonance imaging show differences between both syndromes [2].
A difference that might be even more striking, is that the broken heart syndrome is more common in women (90%), and that it is generally preceded by a stressful event [4]. In a cohort of 1750 patients, it was shown that the broken heart syndrome followed an emotional or physical trigger in 71.5% of the cases [4]. Examples of emotional triggers, observed in 27.7% of the cases, include violence, serious financial problems, but also… Losing a loved one [3, 4].
Luckily, there is also some good news. In case you were heartbroken this Valentine’s day, do not lose hope for next year. A broken heart, just as a broken heart syndrome, is reversible and has a relatively good prognosis [5].
Do you want to know more about the differences between broken heart syndrome and myocardial infarction? Have a look at the following article: https://tinyurl.com/y5pej89k
References:
[1] Sato, H. Tako-tsubo-like left ventricular dysfunction due to multivessel coronary spasm. Clinical aspect of myocardial injury : From ischemia to heart failure, 56-64 (1990).
[2] Lyon, A.R., et al. Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology. European journal of heart failure 18, 8-27 (2016).
[3] Medina De Chazal, H., et al. Stress Cardiomyopathy Diagnosis and Treatment: JACC State-of-the-Art Review. Journal of the American College of Cardiology 72, 1955-1971 (2018).
[4] Templin, C., et al. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. The New England journal of medicine 373, 929-938 (2015).
[5] Elesber, A.A., et al. Four-year recurrence rate and prognosis of the apical ballooning syndrome. Journal of the American College of Cardiology50, 448-452 (2007).
