Stress breaks the heart


Dr. Pura Henríquez, Intensive Care Cardiologist, Coordinator of the Cardiovascular Unit of the General Hospital of the Plaza de la Salud.

Tako-tsubo cardiomyopathy (STK) known as stress cardiomyopathy and broken heart syndrome, first described in Japan in 1990 by Sato et al., Is a sudden, transient heart syndrome that simulates an acute coronary syndrome (a heart attack ).

Patients present with chest pain, changes in the electrocardiogram and elevated cardiac enzymes consistent with a heart attack. However, when the patient goes to cardiac catheterization there is no significant occlusion of the arteries that carry blood to the heart (coronary).

The exact etiology of broken heart syndrome remains unknown, but seems to be triggered by a significant emotional or physical stressor. Usually there are changes in the contractility in the echocardiogram, coronary angiography without evidence of rupture of plaques, changes in the electrocardiogram suggesting infarction, elevation of cardiac enzymes, and absence of myocarditis (inflammation of the heart muscle).

The most discussed mechanism is the release of stress-induced catecholamines with toxicity and subsequent myocardial stunning. It occurs in susceptible individuals, notably women.

Neurohormonal stimulation results in myocardial dysfunction, as seen in the contractility abnormality of the left ventricle wall.

Cases have been reported after use of cocaine, methamphetamines and excessive use of phenylephrine.

The etiology is the occurrence of coronary artery spasm, damage to microvascular cardiac function, damage to myocardial fatty acid metabolism, acute coronary syndrome with reperfusion damage, microinfarction, and endogenous catecholamine-induced myocardial stunning and underlying endothelial dysfunction. .

Risk factor's. A significant emotional or physical stressor or neurological damage typically precedes the development of stress cardiomyopathy.

Stressors include:
• The news of the death of a loved one
• Bad financial news
• Natural disorders
• Motor vehicle collision
• Exacerbation of chronic disease
• A disease diagnosed with Novo.
• Surgery
• Be in an intensive care unit
• Use or withdrawal of illicit drugs.

Tako-tsubo cardiomyopathy has been reported in episodes of near drowning. Seizures can also stimulate broken heart syndrome.

When the literature is systematically reviewed, it is observed that it is more frequent in women and that physical stress exacerbates the disease more than mental stress. The clinical presentation is similar to other heart diseases.

Studies report 1.7-2.2% of patients in whom an acute coronary syndrome is suspected, the diagnosis was of a broken heart syndrome. Patients are typically Asian or white (40% white and 2.8% from other races). The average age reported is 67 years, although it has occurred in children and young adults. About 90% of cases correspond to postmenopausal women.

The prognosis of broken heart syndrome is typically excellent, since about 95% fully recover in a period of 4 to 8 weeks.

Posted in: Hoy Digital newspaper.

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