Un-Broken Heart: Positive stress also affects the heart

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Devastating chest pain, oppression of the heart, shortness of breath - all symptoms point to a heart attack. An examination with the cardiac catheter shows, however, that it is not at all. Even so, the left ventricular dysfunction underlying the symptoms is an emergency. The trigger is stress - and not only more negative, but also more positive.

Death of a relative, loss of job - such massive emotional shocks can put a considerable strain on the heart. In some people it reacts with symptoms that are confusingly similar to a heart attack. Doctors call the phenomenon “Broken Heart Syndom” or “Stress Cardiomyopathy”. It occurs mainly in postmenopausal women who are under severe psychological stress. What is new is the realization that even extremely happy events can have such an effect.

Heart attack symptoms after a happy event

Researchers led by Jelena Gheri from the University Hospital in Zurich have investigated whether positive stress can also trigger cardiomyopathy. In fact, they found what they were looking for: Among 1,750 patients with the diagnosis, 20 (4 percent) were in whom the symptoms had not been preceded by a negative, but a positive experience. Including the birth of a grandchild, a wedding, the victory of a rugby team and a hit jackpot. The researchers therefore called this variant of stress caridomyopathy “Happy Heart Syndrome”.

The scientists suspect that positive and negative stress can activate the same nerve pathways that ultimately provoke the heart trouble. Exactly how this works and why stress leads to a "Broken Heart Syndom" more often than a "Happy Heart Syndrome" is still unclear. Possibly the load limit for the cardiovascular system is higher in the case of happiness.

Positive stress is also a burden

However, it is not new that positive experiences are not all good. Life events such as a wedding, a birth or a career jump, as well as negative stressors, can precede depression or other mental illnesses.

"Our results expand the clinical spectrum of the syndrome," says Ghadri. Doctors should expect that patients who are admitted with suspected heart attack shortly after a happy event may have developed "happy heart syndrome".

Stress cardiomyopathy is rare. Experts estimate that it causes the symptoms in about two percent of all patients who are hospitalized with suspected acute coronary syndrome. For the study, Jelena Gheri's team had to collect data from a total of 26 European and US centers in order to arrive at a sufficiently high number of cases.

Bloated ventricle

Stress cardiomyopathy causes the tip of the left ventricle to inflate. Japanese scientists found its shape resembling an octopus trap and named the syndrome "Tako Tsuko" after such a trap. In addition, since the exit to the main artery is severely narrowed, not enough blood is pumped into the body.

Constricted, blocked coronary arteries and dead tissue, which are typical of a heart attack, are not found. In the acute state of the syndrome, however, life-threatening complications can occur, which is why the patient must be monitored by intensive care. Most of the time, the function of the heart returns to normal after a few days to weeks.

The exact mechanisms of the disease are not yet known - and also why it only affects a few people. However, stress hormones such as adrenaline and noradrenaline, which are usually significantly increased in patients, play a decisive role. They may provoke a response from the autonomic nervous system. (cf)

Source: Jelena R. Ghadri et al. : Happy heart syndrome: role of positive emotional stress in takotsubo syndrome, European Heart Journal; 03/02/2016; 10.1093 / eurheartj / ehv757

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