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Winter Blues: Broken Heart Syndrome

The advent of winter, the holidays, and the celebration of a New Year brings joy, hope, and renewed optimism to many across the globe. However, this is a rather generic statement, and unfortunately, it doesn’t apply to everyone. Seasonal changes associated with winter also bring shorter days, colder temperatures, and overcast skies. Remember, reduced Vitamin D levels (where's the sun?) can indirectly affect mood, sleep, and appetite amongst other things. This topic also gives us an opportunity to pause and focus on a real cardiac syndrome that has some holiday relevance.

Holidays can be a heartbreaking time for many, especially if they have recently lost a loved one, or even a family pet. Additionally, as most of us can relate, holidays compound stress which can have some adverse effects on our bodies, specifically our heart. We want to make this time of year perfect for our families. Nevertheless, some may say, the only “perfect holiday” happens on the Hallmark channel.

Broken heart syndrome is real, but could also be recognized by a few lesser-known names such as stress cardiomyopathy, or Takotsubo cardiomyopathy. Takotsubo is simply derived from Japanese octopus traps – the shape the LV apex tends to take in this condition. The good news is that most patients can fully recover, as this is generally considered a transient disorder. However, in severe cases, inotropic drugs (dobutamine) and insertion of an IABP can further support the most critical patients. While inpatient mortality is relatively low – most related deaths occur from cardiogenic shock, myocardial rupture, or life-threatening arrythmias.

Source: WSJ research

PEARLS surrounding Broken Heart Syndrome

· Most common in post-menopausal women over 50

· Stress isn’t a mind game – it plays to WIN. Find ways to manage it appropriately

· Symptoms can mimic a heart attack

· EKGs alone can’t reliably differentiate the cardiomyopathy vs. an occlusive MI

· During angiography – the coronaries are clear

· Apical ballooning – is a classic echo finding in 80% of cases

· RV involvement (rare) is a poor prognostic sign

· 1/3 may not even have an identifiable stressor

· Secondary syndromes can happen with infection or in settings of post arrest

December 19, 2022

Author: Joshua Ishmael, MBA (MLS) ASCP, NRP

Pass with PASS, LLC.

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