Broken Heart Syndrome

I was watching TV at the gym (can't remember exactly which tabloid show it was-- you know, I've got the earphones in blaring music and I'm trying to read subtitles while running!) when a story comes on about a woman who can't remember her wedding day.

Ok-- well that's a teeny bit unusual. I'm surmising she must have been in a horrible car accident later that day or something.

No, nothing like that.

They go on to explain that this woman suffered from Broken Heart Syndrome for which my eyes roll several times around my skull as I'm sure this can't be a real medical thing. I mean, tabloid TV, she can't remember her wedding day, Broken Heart Syndrome-- they have totally made this up.

Evidently, they did not.

According to the Mayo Clinic, Broken Heart Syndrome is a "temporary heart condition brought on by stressful situations." Anyone who has been through planning and actually wedding someone knows how stressful that can be. Because of the release of all these stress (adrenaline) hormones, "the heart temporarily enlarges and doesn't pump well." What differentiates this from a normal heart attack is that the coronary arteries aren't blocked though the symptoms might be similar-- sudden onset of chest pain, difficulty breathing and weakness.

Other names it goes by:

• Takotsubo Cardiomyopahy
• Stress Cardiomyopathy
• Stress-induced Cardiomyopathy
• Apical Ballooning Syndrome 

It is treatable and symptoms reverse in a couple of weeks. In this woman's case, however, she suffered cardiac arrest. Her husband was able to revive her but she was comatose for approximately four days-- hence losing all her wedding memories.

Be careful next time you throw someone a surprise birthday party. Make sure their heart can take it.

Sudden Death: The Widow Maker

I'm so excited to have Dr. David Carnahan joining Redwood's as a guest blogger because for a while now I've been wanting to do a series on those things that cause sudden death. When David sent his first hand experience with such a case, the infamous widow maker, I knew he'd be the perfect expert to blog on this topic.

Welcome, David!

It sounds like a name you’d give an advanced military weapon or a designer drug, but in the medical community, it refers to a scenario far too many Americans experience. In 2007, the United States had a little less than a million people present with a new heart attack; while over 400,000 died from Coronary Heart Disease.

The scariest statistic is that over 150,000 Americans died of cardiovascular disease who were less than 65 years of age.² No matter how you slice it, Coronary Heart Disease has been the uncontested leading cause of death for many years, and the widow maker is a significant reason why.

Why is the widow maker especially dangerous?

It comes down to the anatomy. The blood vessels to the heart branch very early into the right and left coronary arteries. The primary purpose of these arteries is to feed nutrients and oxygen to the heart itself.

The right coronary artery is not as critical because it provides blood flow to the right side of the heart, which is the proverbial weakling who gets sand kicked in his face. Sure, it will hurt and cause damage, but nothing like the other side of the heart.

The left coronary artery starts as an artery we call the left main artery, but quickly divides into two other arteries: the left circumflex (not important to know), and the left anterior descending artery (also referred to as the ‘LAD’). If the left main or LAD arteries are blocked with cholesterol plaques and then a blood clot shows up, the patient could die in minutes.

You might be wondering why? How could these blockages cause the whole body to die?

It really comes down to a simple principle: without oxygen, every organ in the body will die. These arteries provide oxygenated blood to the left side of the heart, which pumps oxygen to the rest of the body. This makes this part of the heart crucial to your body’s survival. So, if the blockage kills the left side of the heart (a.k.a. the left ventricle) then the rest of your body will follow suit.

The scary thing about the widow maker is that there can be little warning that there is a problem. The press is full of examples of young, healthy people who suddenly die due to a blockage in these critical areas.

One striking example was Daryl Kile, a professional baseball pitcher for the St. Louis Cardinals, who died at age 33 while resting before a game. The manager had to break down the hotel door when he wouldn’t answer his messages.³ Autopsy showed he had two arteries that were completely blocked – I’m betting one of them was the left main or the LAD.

Another recent example was Tim Russert of Meet the Press notoriety. He died at the age of 58 while working in preparation for another Sunday morning show. Despite having a colleague witness the collapse and immediately start CPR (cardiopulmonary resuscitation) and having EMS arrive at the scene within 5 minutes of the 911 call, he was pronounced dead within an hour of his collapse.⁴

So, when you hear someone refer to a widow maker or when you plan to use it in your writing, the important thing to realize is that it is primarily a designation of the location of the blocked artery: usually the left main artery or a proximal LAD lesion. Though, it would be a cool name for a super secret military weapon.

References:

1. Words that Harm, Words that Heal. [Interesting article about how doctors use language and why they may use the terms they use] http://archinte.jamanetwork.com/article.aspx?articleid=217147

2. American Heart Association Statistical Update on Acute Myocardial Infarction. http://circ.ahajournals.org/content/123/4/e18

3. Daryl Kile: http://www.nytimes.com/2002/06/25/sports/baseball-heart-disease-can-hit-even-the-young-like-kile.html?ref=darrylkile

4. Tim Russert: http://en.wikipedia.org/wiki/Tim_Russert\

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Dr. David Carnahan is a Board Certified Internist, who fell in love with writing while getting his Masters Degree in Epidemiology at the University of Pennsylvania. He has served in the Air Force for the past 14 years as an academic clinician/educator and now works in the area of Healthcare Informatics. He has a wonderful wife and two beautiful daughters, and invites you to read about his life (www.dhcarnahan.blogspot.com), and weekly installments of his current work in progress, The Perfect Flaw (www.theperfectflaw.com).

Author Beware: Delusional Diagnosis (2/2)

Last post, I discussed the issue of heart palpitations and how, in isolation, they can be benign and not representative of heart disease.

The line in this particular published novel that did get my ire up is shortened as follows: "Any experience terrifying enough to cause a panic attack, in extreme circumstances, causes an arrhythmia. That's a heart attack."

Really? No. There's a lot medically wrong with this sentence.

First, in very general terms, a heart attack is caused from lack of oxygen to the heart muscle, generally from a clot in an artery that feeds blood to the heart-- your coronary arteries. When the heart muscle is not getting oxygen, it becomes irritable. One interesting thing about your heart is that each cell can generate an electrical current that will contract heart muscle. It generally does not do this due to the over-riding normal pacemaker. However, when oxygen is cut-off and the heart cells become irritable, they can begin to fire outside the normal conduction system.

When this happens, the medical team begins to see aberrant beats. But see, the heart attack itself generally causes the arrhythmia, not the other way around.

Let's stay on track with this character. A healthy, college age woman. The incidence of actual heart disease is going to be low. What causes chest pain during a panic attack? Generally, the heart rate may be faster than usual. However, the truly rapid heart beat of SVT (more on that later) I would say is rare and would point away from the mind and more to the conduction system in the heart.

The last thing to consider is that people who have true heart arrhythmias, may have structurally fine hearts. Meaning the muscle, valves, and coronary arteries are good. Just the conduction system is a little funky.

My advice for authors-- don't make blanket medical statements. Just like they taught you in school-- sentences that have all, every, etc... are likely the wrong answer.