The term “broken heart” always reminds me of that quintessential ’70s song by the Bee Gees, the one that asks for advice on how to mend one so the singer can “…liiiiiiive again.”
The ballad is a little melodramatic, but, as it turns out, not overly so! New research has identified that some people have a vascular abnormality that may make them vulnerable to a heart attack as a result of suffering intense emotional anguish. It turns out that these patients have blood vessels that react very differently to stress than those of other people, triggering physiological changes that may increase vulnerability to heart attack — and, in extreme cases, actually bring one on.
The medical name for broken heart syndrome is apical ballooning syndrome (ABS). Seen in men and young women only very occasionally, the problem mainly affects postmenopausal women, probably because menopause brings hormonal shifts that change the way their blood vessels respond to stress.
Amir Lerman, MD, a Mayo Clinic cardiologist and coauthor of a recent study on the topic (published in the Journal of the American College of Cardiology), told me that awareness of this problem has grown in recent years. He and others are now working to take the knowledge further and develop a way to identify these very sensitive people in advance so that they can take steps to avoid the problem.
The study: To learn more about the cause of this condition, researchers examined 28 postmenopausal women — 12 with ABS, 12 without ABS and four who had suffered classic heart attacks. The participants were asked to complete a series of mental stress tests, including complex memory and mathematical tasks. As they did this, researchers used a finger cuff (called an EndoPAT) to monitor changes in their blood volume as a way to determine how their blood vessels reacted when they were experiencing mental stress.
Normal blood vessels dilate during stress, allowing more blood to flow to the heart, but the opposite occurs in people with ABS. Researchers found that, compared to both other groups, these patients had “decreased endothelial function,” causing their blood vessels to constrict under stress. The endothelium or inner layer of the vessels regulates the activity of the vessels, allowing blood flow to increase when we’re in demanding situations, such as exercising or under mental stress. Endothelial dysfunction also can contribute to decreased blood flow to the heart, which — if dramatic enough — can lead to a heart attack and also to weakening of the left ventricle, the heart’s main pumping chamber.
“If you’re under stress and your blood vessels narrow rather than dilate, there’s a discrepancy between how much blood flow you need and how much you get,” explains Dr. Lerman, noting that this is what causes the chest pains or shortness of breath that ABS patients often experience. The good news is this isn’t usually as dangerous as it feels. There’s no actual blockage involved with ABS and it usually doesn’t cause permanent damage, he said.
Might you have ABS? Well, if you have noticed that when you’re really stressed your chest hurts and you’re short of breath, then Dr. Lerman advises that you discuss the condition with your doctor. He suggests asking to have your endothelial function tested with noninvasive devices, such as the EndoPAT used in the study, and adds that it’s a good idea for anyone who has experienced heart attack-like symptoms but hasn’t actually had a heart attack to be tested as well.
Dr. Lerman told me that people with ABS usually respond quite well to treatment, which may involve medication, such as beta-blockers and other drugs to lower blood pressure, and/or relaxation techniques, such as meditation or yoga, to help them learn better ways to handle stressful situations. The goal, said Dr. Lerman, is for people to learn coping skills that bring greater resilience so that they can learn to tolerate sadness and loss without allowing it to, literally, “break their hearts.” It’s a simple and healthful fix — for all of us, in fact, not just people who have ABS!
