It May Not be a Heart Attack

Doctors Have a Real "Broken Heart" Problem Needing Proper Diagnosis

Feb 18, 2009 Wendy J Meyeroff

It feels like a heart attack, but it isn't. And a clean EKG doesn't mean you aren't in danger.

It’s a heart disorder few people have heard of. It’s called stress cardiomyopathy (car-dee-o-my-OP-a-thee) or more commonly “broken heart syndrome”.

The initial symptoms of stress cardiomyopathy are the same ones bringing most people to the ER for a heart attack; e.g., chest pains, trouble breathing, and nausea. That can make a diagnosis difficult.

Two things make getting a correct diagnosis even harder. Not only are many doctors and nurses still not trained in this disorder, but an EKG—the most utilized heart diagnosing tool—often doesn’t catch it. Exact numbers aren’t exact, but there have been some estimates that the EKG can show normal in 60% of cases.

Dr. Ilan Wittstein at Johns Hopkins Medical Center in Baltimore, Maryland once offered six checkpoints to help his team distinguish if the patient was suffering from stress cardiomyopathy. He's urged ER doctors to look for these:

Significantly elevated levels of stress hormones like adrenaline and noradrenaline—According to Wittstein these hormones are five times higher compared to heart attack patients, and 30 times higher than a normal person’s.
The EKGs look different—One of the reasons stress cardiomyapthy doesn’t immediately ring a warning bell for doctors is that it doesn’t show the same distinct changes on their EKG readouts that they see when their patient is having a heart attack.
Normal triponin levels—Another key doctors look for in heart attacks is a heightened level of an enzyme called triponin. That’s always elevated when someone’s had a heart attack, but people with broken heart syndrome generally show perfectly normal levels (or the elevation is so small as to be considered unimportant).
Normal arteries—Patients showed no blockages or clots when Wittstein’s team looked at their diagnostic tests when the syndrome was first diagnosed.
Unusual heart shape—One thing that does show up is a strange pulsing in parts of the heart. The unusual shape: the base of the heart seems to be squeezing fine, but the mid and top were very much affected. That shape is always seen on an ultrasound.
Heart returns to normal fairly quickly—For most people, an ultrasound shows a perfectly normal heart muscle within 3 days. That is unheard of in heart attacks.

Reconsider The Statistics

Two percent doesn’t sound like a statistic to worry over, so when people hear stress cardiomyopathy only affects about 2% of the people who go to the cath lab to get their heart checked it doesn’t seem like something to fret over. But experts point out that considering how many people are sent to cath labs every day, 2% is still a significant number.

Bottom line: If you have just had something stressful—a breakup, someone has died—and you are having chest pain, don’t try and diagnose yourself. People die of broken heart syndrome if they’re not treated properly. The good news is they can recover completely if it’s caught and treated quickly.

The copyright of the article It May Not be a Heart Attack in General Medicine is owned by Wendy J Meyeroff. Permission to republish It May Not be a Heart Attack in print or online must be granted by the author in writing.