What is Stress Induced Cardiomyopathy

Stress induced cardiomyopathy is a disease of the heart muscle that is caused by extreme stress. It is also known as broken heart syndrome, apical ballooning syndrome, or takotsubo cardiomyopathy.

Cardiomyopathy makes the heart muscle thick, weak, or stiff. In stress-induced cardiomyopathy, the heart weakens and bulges. When this happens, it cannot pump blood properly. People often mistake this condition for a heart attack because the most common symptom is chest pain (angina).

Stress-induced cardiomyopathy can lead to severe heart failure. However, the failure is usually short-term. Most people with this condition make a full recovery.

What are the causes?

The exact cause of this condition is not known. Symptoms are usually caused by extreme stress brought on by anger, surprise, or grief (such as the death of a loved one or a divorce). Body chemicals (hormones) released while experiencing stress may affect the heart’s ability to pump blood.

What increases the risk?

You are more likely to develop this condition if:

• You are a woman, especially if you have gone through menopause (postmenopausal).
• You are Asian or white (Caucasian).
• You have no history of heart disease.

What are the signs or symptoms?

Common symptoms of this condition include:

• Sudden angina.
• Shortness of breath.

Other symptoms include:

• Irregular or fast heartbeats (arrhythmia).
• Fainting.
• Low blood pressure.
• The heart not being able to pump enough blood (cardiogenic shock).
• Heart failure.

How is this diagnosed?

This condition is diagnosed based on:

• Your symptoms and medical history.
• A physical exam.
• Blood testing. This is done to check for troponin levels in the blood. Troponins are proteins that are released when there is damage to the heart muscle.
• An electrocardiogram (ECG). This test is done to check for problems with electrical activity in the heart.
• An echocardiogram. This test involves making an image of your heart using sound waves. It can show how well your heart is pumping blood.
• Coronary angiogram. During this test, a thin tube (catheter) is inserted into a blood vessel, and dye is injected into your bloodstream (cardiac catheterization). The dye appears on an X-ray and shows how blood flows through the arteries in your heart.
• Ventriculogram. This test is done during a coronary angiogram. A dye is injected into your heart. The dye appears on an X-ray and shows how well the upper left chamber of the heart (left ventricle) can pump blood.
• Chest X-ray.
• MRI.

How is this treated?

This condition may be treated with:

• Medicines. These may include:
  • Anti-anxiety medicines to manage stress.
  • ACE inhibitors to lower blood pressure.
  • Diuretics to reduce swelling and prevent fluid buildup in the lungs.
  • Beta-blockers to lower blood pressure and heart rate. They also reduce the workload of the heart muscle.
• Lifestyle changes, such as managing stress and losing weight.

You may also be treated for complications caused by stress-induced cardiomyopathy, such as heart failure, shock, or heart rhythm problems.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.

Eating and drinking

• Eat a healthy diet. This includes plenty of fruits and vegetables, lean meats, whole grains, and fat-free or low-fat dairy products.
• Avoid foods that are high in salt (sodium), sugar, saturated fat, and trans fat.
• Limit alcohol intake to no more than 1 drink a day for nonpregnant women and no more than 2 drinks a day for men. One drink equals 12 oz of beer, 5 oz of wine, or 1½ oz of hard liquor.

Lifestyle

• Manage your response to stress. Try to do this with relaxation exercises, mindfulness, yoga, quiet time, or meditation.
• Think about taking part in a stress management program. Ask your health care provider for recommendations.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Maintain a healthy weight. Ask your health care provider what a healthy weight is for you.
• Weigh yourself daily. This will alert you and your health care provider if you have sudden fluid buildup in your body.

General instructions

• Exercise regularly. Aim for 150 minutes of moderate exercise (such as walking) or 75 minutes of vigorous exercise (such as running) each week. Ask your health care provider what exercises are safe for you. This may include an exercise program called cardiac rehabilitation.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have any side effects from your medicines, such as depression or fast or irregular heartbeats (palpitations).
• You develop new symptoms, such as:
  • Shortness of breath after exercising.
  • Increased fatigue.
  • Swelling of your ankles, feet, legs, or abdomen.
  • Nausea or a lack of appetite.
  • Rapid heartbeat.
• You have sudden weight gain.

Get help right away if:

• You have sudden, severe chest pain.
• You have shortness of breath that does not go away.
• You faint.

Summary

• Stress-induced cardiomyopathy is caused by extreme stress brought on by anger, surprise, or grief. This disease is also known as broken heart syndrome.
• People often mistake this condition for a heart attack because the most common symptom is chest pain (angina).
• With the right medical treatment, most people with this condition make a full recovery.
• You are more likely to develop this condition if you are a woman who has gone through menopause.