The Head and The Heart

doc heart march_0

We know about heart problems’ link to obesity and inaction. An expert explains a lesser-known link to stress and grief – broken heart syndrome.
Erik Petersen

When Dr. Adam Splaver diagnoses a case of Takotsubo cardiomyopathy, it’s typically in a person who arrived at the emergency room with all the symptoms of a heart attack.

“They have chest pains, they have shortness of breath … pain goes down the arm, up to the jaw. They get sweaty.”

EKG tests show problems associated with heart attacks. So do other tests.

“We see even the enzymes,” says Splaver, a local cardiologist. “Normally there are enzymes that live inside your heart. Those enzymes should never be in the bloodstream.” Now, as with a heart attack, they’re rising and falling within the bloodstream.

So the patient is rushed off for an angiogram – where doctors find that the arteries are okay. “Everything is perfectly normal in terms of the plumbing ,” Dr. Splaver says.

That’s when a different, less widely known explanation sometimes gets offered – Takotsubo cardiomyopathy, better known as “broken heart syndrome.” The non-medical name comes from the stress-related conditions – the death of a loved one, a break-up, stress at work – that often bring on the condition.

While it is serious – and feels like a heart attack – broken heart syndrome is a temporary, curable condition. Preventing it means a mixture of mental well-being and the sorts of common-sense steps that lead to overall heart health.

“These patients, when they come in, end up having a weak heart,” Dr. Splaver says. Part of the treatment is medical: a cocktail of medicines to help the heart pump remodel itself. Beyond that, a holistic approach to health helps heal the “broken heart.” Syndrome sufferers often don’t have the same underlying factors – being overweight, a lack of exercise – that lead to heart problems in others.

“It’s more one’s ability to deal with stress,” Dr. Splaver says. “It’s not a function of what your underlying cardiac status is.

“I will recommend that they need not only the medical support … they need the psychological support. It’s a balanced approach.”
While broken heart syndrome is not the most commonly diagnosed heart condition, Dr. Splaver sees it regularly.

“It’s not something you’re going to see every single day or every week,” Dr. Splaver says. “But every month or so, we get a handful of cases.

“Is there an avalanche of cases? No. But … it’s relatively common.”

It can also go away.

“Usually it resolves itself after several months,” Dr. Splaver says. And if you’ve had it once, you won’t have it again. Little is known about why that is.

“The diagnosis itself has really only been described in the last decade or so. We don’t have enough data to discover why this only happens once in a lifetime.”
But even if it’s not as catastrophic as other heart conditions, broken heart syndrome remains serious. And preventable.

“The key to (prevention) is to maintain your calm, maintain your zen-like atmosphere,” Splaver says. “It always pays to be calm, cool and collected. Find an outlet. Find something where (you) can find that zen-like place.”

Dr. Splaver does CrossFit every morning. For others it might be jogging, pilates or yoga . “In general,” Dr. Splaver says, “it’s always good to find an outlet.”

An activity such as yoga – where, Dr. Splaver says, you’re “taking it off the mat (and) bringing it into your world” – offers crucial mental as well as physical benefits.

Beyond that, Dr. Splaver tells his broken heart syndrome patients the same thing he tells all his patents – do all the common-sense things that make your heart healthy. Exercise. Don’t smoke. Healthy weight means longevity. “People who hit a hundred years old … are they fat or are they skinny? Maintaining a healthy weight improves overall cardiac health.”

And of course, find that little oasis somewhere in your day. Include mental well-being alongside physical well-being. By the time people see Splaver, problems have developed to the point where he needs to write prescriptions. But there are some things a doctor can’t prescribe.

“I wish,” he says, “ I could give everyone a prescription not to be stressed.”