Jan 30, 2014 — When someone says they have a broken heart, most of us think it’s just a metaphor for expressing their extreme emotional pain. But there actually is a medical condition called broken heart syndrome, which manifests itself very much like a heart attack. Dr. John Ryan talks about its causes, symptoms, and how physicians treat a broken heart.

Interview

Host: Can you die of a broken heart? We'll find out next on The Scope.
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We're with Dr. John Ryan, a Director of the Dyspnea Clinic here at the University of Utah. I'm curious. You hear people talk about, "I've got a broken heart." I'm talking about in the romantic state, not those that are not functioning. Is there such a thing as a broken heart?

Dr. John Ryan: There is. Yeah. It's refer to as Broken Heart Syndrome. And this is an entity where in the setting of severe emotional trauma such as death of a loved one, divorce, or loss of a dog. Folks can experience incredible chest pains, shortness of breath, and fatigue. And they can be presented to the Emergency Department and have all the signs and symptoms of a heart attack. And then we take them to the cardiac catheterization lab to see if they've had a heart attack. And lo and behold, all their blood vessels are widely opened, and as it turns out, they've had a severe adrenaline surge from the emotional stress that they've been exposed to. Their heart has severely decreased in function from that. However, you've got to remember that it is an uncommon cause of decreased heart function. The most common reasons for decreased heart function is still heart attacks, high blood pressure, and hereditary components. But it is definitely a well described entity.

Host: So is it just like a heart attack then? I mean, as far as how it could affect you?

Dr. John Ryan: Yeah. So it presents just like a heart attack, and it can affect you just like a heart attack. The medicines you use are the same and then obviously emotional counseling in order to try and better cope with whatever emotional tumult has resulted in this Broken Heart Syndrome. The other thing, of course, is that emotional trauma can also trigger regular, true blue heart attack, and that's well described, too. So it is important to try and differentiate the two being relatively similar.

Host: As a physician, is there any way of determining the difference between the two without actually going into the cardiac lab?

Dr. John Ryan: No. Unfortunately not. And also in terms of the fully blocked arteries, when the large arteries are blocked, time is muscle in that regard. So you don't really have the luxury to decide, "Well, maybe it's an emotional trauma resulting in blockages of small vessels or maybe it's the big vessel." Ultimately, you need to go to the cardiac catheterization lab as soon as possible. The Broken Heart Syndrome in that regard is a diagnosis of exclusion once you rule out the more sinister, immediately life-threatening form. As I said, that's oftentimes when the history is more apparent that recently their husband of 50 years just passed or they lost their dog, and so on.

Host: Could that differ from person to person when you have two people and both of their husbands?

Dr. John Ryan: Yeah. It all depends on what you perceive as emotional trauma.

Host: So it's actually kind of a head thing at that point?

Dr. John Ryan: It is. Yeah. Many people refer to it as a neurocardiac syndrome or cranial cardiac is another term people use because, again, it depends on how you react to whatever emotional trauma you have been exposed to.

Host: Is there something you can do to help lessen your chances of a broken heart?

Dr. John Ryan: Yeah. Yeah. Aside from not attaching yourself too much to your dog, there's really very little that can be done until after the fact. And then obviously, you take the medicines and you engage into the emotional counseling.

Host: So it sounds like this heart attack is actually caused more from the brain than from the actual failure of the heart?

Dr. John Ryan: Yeah. So their hearts prior to the event are normally functioning. Their coronary arteries are normal, and the upshot is, is that after the event, everything can come back to normal. Then once the medicines are on board and once the emotional counseling is on board, everything can come back to normal. Oftentimes, it does not end up as long-term deleterious consequences from this.

Host: Isn't that amazing to you that the brain can actually cause the heart to fail?

Dr. John Ryan: It is. It is, and it isn't because, obviously, most of what we do, the brain also trains us to succeed. So when you're obviously engaged in a severe competitive event such as international Olympics or even your pick-up soccer league, obviously your performance is oftentimes improved by the fact that you are under stressed and you take it seriously. It improves your cardiac function in that regard. So just the same way that it can help you, obviously there's the opposite side of things as well. Emotional trauma can hinder you.

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