The current covid pandemic has wreaked havoc in people’s lives as well as their minds around the world. The extended lockdown, the uncertainty associated with the disease, the loss of livelihood, and the significant reduction in social interaction have all contributed to high levels of anxiety and despair.
Amidst this comes a report of a small study in two hospitals in a US city, which shows a two-fold rise in the incidence of ‘broken heart syndrome’ during this pandemic as compared to a similar period in the previous years. Importantly, all the patients were covid-negative, as coronavirus infection has also been shown to be associated with acute myocarditis or inflammation of the heart, leading to cardiac dysfunction.
The authors concluded that the syndrome was likely connected to the “psychological, social, and economic stress” caused by the pandemic.
So what is broken heart syndrome?
Takotsubo cardiomyopathy, also known as stress cardiomyopathy and broken heart syndrome, is a condition which mimics an acute heart attack in clinical presentation—sudden severe chest pain or shortness of breath. Electrocardiogram and blood tests also show abnormalities that are seen typically in a heart attack.
However, when the affected patient undergoes cardiac angiography, no significant blockages or narrowing of the heart arteries are seen. Instead a typical ballooning of a portion of the heart cavity is seen, which is diagnostic of this condition. First described in Japan in 1990, its name is derived from the Japanese word takotsubo which means an “octopus pot,” which refers to the resemblance of the shape of the heart to this pot.
The broken heart syndrome is more common in women
Worldwide research suggests that broken heart syndrome is more commonly seen in women than in men. That too particularly in postmenopausal women of Asian and Caucasian descent. While experts are still trying to find out why it is more prevalent in women, some studies point towards factors such as hormonal differences between the two sexes and variations in coronary arteries.
And it’s closely related to stress
The exact cause of this syndrome is not fully understood. It is also known as stress-induced cardiomyopathy, and as the same suggests, in most of the cases the symptoms are triggered due to emotional or physical stress. These stressors could be any of the following: natural disasters, shock due to death of a close relative or friend, financial problems, personal trauma, accidents, surgery or a serious medical illness.
Unlike a typical heart attack, for which the peak occurrence is during the morning hours, takotsubo cardiomyopathy events are most prevalent in the afternoon, when stressful triggers are more likely to take place. Stress leads to release of adrenaline, which is toxic to the heart. It causes dysfunction or failure of the heart muscle in such patients. The exact mechanism is not known. Whether this is triggered by multiple levels of spasms in the heart arteries, formation of multiple clots in the heart arteries, or direct cardiac toxicity remains to be seen.
It can be treated though…
Because the broken heart syndrome mimics a typical heart attack, the approach to treatment of this condition is same which includes ICU admission, appropriate cardiac medications, management of complications if any, and undergoing a coronary angiography procedure, which usually clinches the diagnosis. These patients do not require angioplasty or heart bypass surgery.
The good news is that such patients usually make a full and fast recovery. Nearly 95% of patients experience complete recovery within 4-8 weeks, though the death rate varies from one to three per cent.
Learning to cope with stress is the key to prevention
There are limitations to this recent study that says that broken heart syndrome has increased during the covid-19 pandemic. Firstly, it is a small study and suffers from methodological flaws which can lead to biased findings. And secondly, these observations need to be confirmed in a larger study from multiple centres, since this pandemic is global.
But it also brings to focus the undeniable impact of the covid pandemic on the mental health of the population, which should not be ignored. Fear and stress are normal reactions to perceived or real threats.
Therefore people are urged to learn stress-management and relaxation techniques for both physical and mental wellbeing. As people follow the social distancing norms and stay homebound, unhealthy habits such as drinking, smoking, and binge eating should not be encouraged. Regular physical activity- be it a 15-30 minutes of aerobics exercise at home, and yoga and meditation for a peaceful mind should become the way of life.