The researchers say that the stress caused by the natural disasters, including Tropical Storm Irene and a devastating tornado, likely triggered the increase in cases.
Takotsubo cardiomyopathy is characterized by a temporary enlargement and weakening of the heart muscle, which is often triggered by extreme physical or emotional stress, according to researchers at the University of Arkansas, who presented the study at the American College of Cardiology’s 63rd Annual Scientific Session.
For the study, the researchers identified 21,748 patients diagnosed with primary cases of broken heart syndrome in 2011 using a nationwide hospital discharge database. After mapping the cases by state, Vermont and Missouri emerged as having the highest rate of cases, with 380 cases per million residents in Vermont and 169 per million in Missouri, according to the researchers.
In contrast, most states had fewer than 150 cases per million residents. New Hampshire and Hawaii had the lowest rate of the disease that year.
But the rate of broken heart cases in Vermont in 2011 was more than double most other states. This was the same year that Tropical Storm Irene pummeled the state with heavy rain and wind, causing the most devastation Vermont has experienced since the Great Flood of 1927, the researchers report.
In Missouri, researchers found broken heart syndrome at a rate of 169 cases per million in 2011, the same year a massive tornado ripped through Joplin, demolishing neighborhoods and killing at least 158 people.
“Despite the seemingly increasing number of natural disasters we have, there is limited data about how it might affect the heart,” said Sadip Pant, M.D., an internist at the University of Arkansas for Medical Sciences, and lead investigator of the study.
Patients with broken heart syndrome often complain of chest pain and shortness of breath, symptoms that mimic those of a heart attack, which can delay diagnosis, he noted. In addition, biomarkers in the blood and changes on an electrocardiogram can raise suspicions of possible heart attack.
While broken heart syndrome typically resolves within a month or two, it can result in serious complications, such as heart failure, life-threatening arrhythmias, and stroke.
Previous studies by the same researchers found that as many as one in four patients with broken heart syndrome have some form of arrhythmia, while between one to seven percent suffer cardiac arrest.
Many patients with broken heart syndrome are diagnosed in the cath lab when doctors see there are no blockages in the artery, or imaging reveals changes in the shape of the heart that are characteristic of the syndrome, the researchers explained.
“By and large, it is a very reversible form of cardiomyopathy, but in the acute phase these patients need to be monitored closely to be sure they are stable and to prevent and manage problems,” Pant said.
“It’s also something that emergency doctors and medical personnel need to be aware of as they are often on the frontlines seeing patients after disaster strikes.”
Episodes are thought to be driven by the sympathetic response and surges of adrenaline in the body, similar to the fight-or-flight reaction, he noted. This leads to depressed function of the apex and middle segment of the heart and increased contractility of the base, producing a balloon-like appearance, he explained.
“It’s a perfect example of our brain-heart connection,” Pant said. “The emotional stress we have in our brain can lead to responses in the heart, and not much is known about this condition.”
“Hospital admissions for broken heart syndrome have been on the rise, but it is unknown whether the growing numbers are due to doctors being more aware of the condition, especially since a reimbursement billing code was established for it in 2006, or if there is a true increase in its incidence,” he said. Either way, he notes it is important to identify potential triggers.
Source: American College of Cardiology