House Calls runs every two weeks. Today's column is written by Randy Landenberger, registered diagnostic cardiac sonorophone at Sutter Coast Hospital.
And now for something completely different - a condition that cannot be prevented by vitamins, exercise, red wine (darn!) or any other health measure.
There are some facts, some opinions, and some theories. Bottom line on chest pains though: Don't try to diagnose yourself. Don't delay. Get bona fide medical help.
Even if it is "just" a broken heart.
I've always thought it quite miraculous that memories can be stored in our brains. If you get a head injury or disease, you may lose reminiscences. A surgeon poking around in your skull can bring back images and recollections you'd thought long gone.
We possess another type of memories, not visual, auditory or olfactory, and I don't think they're stored in our brains. These are our emotional memories, the good, the bad and the ugly.
There is a theory I subscribe to, that emotional memories are stored in our muscles. Poets, philosophers, song writers and storytellers have been telling us this since the Dark Ages. Massage and physical therapists have many a tale of the emotions or psychological traumas that are re-lived or released when a client has his or her muscles worked on.
You've heard about a happy heart, a heavy heart, or the dreaded broken heart. Think about the joyous times in your life, and then think about the darkest day. You may not see much in that movie up in your head, but chances are you're feeling it in your chest.
A good writer or Hollywood director knows how to "tug on your heart strings" and get you to weep with joy or despair. Those tears may come from your eyes, but I say they start in your heart. Most of us learn to deal with the day-to-day stress of life, but now and again you may get hit by an emotional freight train which literally breaks your heart.
"The silence of a falling star
Lights up a purple sky.
And as I wonder where you are
I'm so lonesome I could cry."
Hank Williams hit that nail on the head when he wrote "I'm So Lonesome I Could Cry." Feeling alone or abandoned is the straightest road to heartbreak.
Broken heart syndrome, also known as Takotsubo's Syndrome or stress cardiomyopathy is the real deal. Feels like a heart attack, looks like a heart attack and may well kill you if untreated. The good news is that it's mostly a transient condition.
In Japan (where this condition was first documented) an Octopus Trap (Toko-tsubo) is an urn-shaped jar with a narrow mouth. That's the shape the main heart chamber transforms to with this syndrome. We can see this when imaging the heart by echocardiogram or cardiac catheterization - and it's not a pretty sight. It appears the patient has suffered a massive heart attack where half (or more) of the heart is dead or damaged. However, when the coronary arteries are checked, they are not blocked or clogged up as we would expect. This left doctors scratching their heads and confused.
Dr. Ilan Wittstein, a cardiologist at Johns Hopkins Hospital, began to see a connection with patients suffering this condition and the unusual fact that it often times disappeared and the heart returned to normal size and function. The strongest link in these patients was that they had recently gone through a traumatic emotional episode such as the death of a family member, close friend or pet; a divorce; armed robbery; domestic abuse; court appearances or lawsuits; job or large financial losses, to name a few.
Secondly, most of the patients were women, most of them over 50 years old and post-menopausal. Most of their symptoms came on very quickly, just like a full-blown heart attack. They were all suffering from a broken heart, literally and figuratively.The theory is that massive amounts of the hormones released by the "fight or flight" response were overwhelming the heart, causing it to shut down in order preserve itself.
The very first thing the patient who is feeling heart pain and attack symptoms needs (often times after the Echocardiogram detects the dysfunction) is a cardiac catheterization (wire and tube into the heart) to check the arteries. With that information the cardiologist can decide the best plan of treatment.
If the arteries are clear and the cardiologist determines this is a case of Takotsubo's, in most cases standard heart failure medications help relive the load and the symptoms, and recovery begins. Given time and help from the medications, the heart can heal itself in a remarkably short term. In extreme cases drastic intervention is needed to keep patients alive and their hearts from completely giving out.
Another theory states that simply the act of talking about the situation to a supportive person of authority (the doctor, or health team) can begin the heart's unloading of the pain and burden, and begin recovering.
There are occasions when Takotsubo's is not caused by overwhelming emotions. The stress may come from viral infections or reactions to chemicals or medications. There's still a lot we don't know and a lot of theories to be investigated. Again the bottom line is: Seek professional medical help for your chest pains.
Recovery is different for every patient. Yes, some patients die from this condition. Many come close, but with quick, proper diagnosis and treatment, most will recover completely. Although most patients take a few months to return to normal heart function, noticeable improvement may begin within a few days.
For those of us who are in the imaging profession, this is one of the near-miraculous turn of events we witness: Seeing a patient whose heart appears to have one foot in the grave and the other on a banana peel, return to normal size and function within a week is enough to make you weep andhellip; with joy.
I leave you with some Josh Ritter lyrics:
"Oh the heart has no bones you say, so it won't break
"But the purpose of loving is the pounding it takes."