Broken Heart Syndrome - Takotsubo Syndrome

 

Broken heart

From Wikipedia, the free encyclopedia

A broken heart (or heartbreak) is a common metaphor used to describe the intense emotional pain or suffering one feels after losing a loved one, through death, divorce, breakup, moving, being rejected, or other means.

Heartbreak is usually associated with losing a spouse or loved one, though losing a parent, child, pet, or close friend can also "break one's heart". The phrase refers to the physical pain one may feel in the chest as a result of the loss. Although "heartbreak" is usually a metaphor, there is a condition - appropriately known as "broken heart syndrome" - where a traumatizing incident triggers the brain to distribute chemicals that weaken heart tissue.

Contents 1 Philosophical views 2 Religious views 2.1 Buddhism 3 In classical references 4 Broken Heart Syndrome 5 Feelings associated 6 See also

Philosophical views

For many people having a broken heart is something that may not be recognized at first, as it takes time for an emotional or physical loss to be fully acknowledged. As Jeffrey Moussaieff Masson states:

Human beings are not always aware of what they are feeling. Like animals, they may not be able to put their feelings into words. This does not mean they have no feelings. Sigmund Freud once speculated that a man could be in love with a woman for six years and not know it until many years later. Such a man, with all the goodwill in the world, could not have verbalized what he did not know. He had the feelings, but he did not know about them. It may sound like a paradox — paradoxical because when we think of a feeling, we think of something that we are consciously aware of feeling. As Freud put it in his 1915 article The Unconscious: "It is surely of the essence of an emotion that we should be aware of it. Yet it is beyond question that we can 'have' feelings that we do not know about."

 Religious views

Buddhism

Regarding the sadness of loss and heartbreak, the Buddha had the following admonition:

O, monks! Why should every female, male, layperson, or priest always consider that all things they love would one day go away from them? What is the advantage of taking the said matter into consideration? Hearken, monks! All fondness and love existing in the beings lead them to perform physical, verbal or mental bad deeds. Upon having always taken such matter into consideration, the being will be able to leave or lighten such fondness and love. O, monks! That is the advantage that every female, male, layperson, or priest should always consider that all things they love would one day go away from them.

 In classical references

This biblical reference highlights the issues of pain surrounding a broken heart:

Psalm 69:20 Insults have broken my heart and left me weak, I looked for sympathy but there was none; I found no one to comfort me.

In this Psalm, King David says that insults have broken his heart, not loss or pain. It is also popular belief that rejection, major or minor, can break an individual's heart. This heartbreak can be greatly increased if rejected by a loved one or someone whom you respect.
Plays of William Shakespeare feature characters dying from a broken heart, such as Ahenobarbus.

 Broken Heart Syndrome

In many legends and fictional tales, characters die after suffering a devastating loss. But even in reality people die from what appears to be a broken heart. Broken heart syndrome is commonly blamed for the death of a person whose spouse is already deceased, but the cause is not always so clear-cut. The condition can be triggered by sudden emotional stress caused by a traumatic breakup, the death of a loved one, or even the shock of a surprise party. Broken Heart syndrome is clinically different from a heart attack because the patients have few risk factors for heart disease and were previously healthy prior to the heart muscles weakening. The recovery rates for those suffering from "broken heart syndrome" are faster than those who had heart attacks and complete recovery to the heart was achieved within two weeks .

 Feelings associated

The symptoms of a "broken heart" can manifest themselves through psychological pain but for many the effect is physical. Although the experience is regarded commonly as indescribable, the following is a list of common symptoms that occur:

• A perceived tightness of the chest, similar to an anxiety attack
• Stomachache and/or loss of appetite
• Partial or complete insomnia
• Anger
• Shock
• Nostalgia
• Apathy (loss of interest)
• Anhedonia (inability to feel pleasure)
• Feelings of loneliness
• Feelings of hopelessness and despair
• Loss of self-respect and/or self-esteem
• Medical or psychological illness (for example depression)
• Suicidal thoughts (in extreme cases)
• Nausea
• Fatigue
• The thousand-yard stare
• Constant or frequent crying
• Takotsubo cardiomyopathy
• A feeling of complete emptiness
• In extreme cases, death

 See also

• Anger
• Combat stress reaction
• Stress cardiomyopathy, also known as "broken heart syndrome"
• Heart
• Heart (symbol)
• Emptiness
• Limerence
• Love
• Loneliness
• Grief
• Suffering
• Physical pain
• Psychological pain
• Interpersonal relationship
• Intimate relationship
• Depression

 
Takotsubo cardiomyopathy

From Wikipedia, the free encyclopedia

 

Takotsubo cardiomyopathy
Classification and external resources
Schematic representation of takotsubo cardiomyopathy (A) compared to the situation in a normal person (B).
ICD-9	429.83
DiseasesDB	33976
eMedicine	article/1513631
MeSH	D054549

The Japanese octopus traps after which this disease is named.

Left ventriculogram during systole displaying the characteristic apical ballooning with apical motionlessness in a patient with takotsubo cardiomyopathy.

(A) Echocardiograph showing dilatation of the left ventricle in the acute phase. (B) Resolution of left ventricular function on repeat echocardiograph 6 days later.

ECG showing sinus tachycardia and non-specific ST and T wave changes from a patient with confirmed takotsubo cardiomyopathy.

Takotsubo cardiomyopathy, also known as transient apical ballooning syndrome,apical ballooning cardiomyopathy,stress-induced cardiomyopathy, broken-heart-syndrome, Gebrochenes-Herz-Syndrom, and simply stress cardiomyopathy, is a type of non-ischemic cardiomyopathy in which there is a sudden temporary weakening of the myocardium (the muscle of the heart). Because this weakening can be triggered by emotional stress, such as the death of a loved one, a break-up, or constant rejection, the condition is also known as broken heart syndrome. Stress cardiomyopathy is a well-recognized cause of acute heart failure, lethal ventricular arrhythmias, and ventricular rupture.
The typical presentation of someone with takotsubo cardiomyopathy is a sudden onset of congestive heart failure or chest pain associated with ECG changes suggestive of an anterior wall myocardial infarction. During the course of evaluation of the patient, a bulging out of the left ventricular apex with a hypercontractile base of the left ventricle is often noted. It is the hallmark bulging out of the apex of the heart with preserved function of the base that earned the syndrome its name "tako tsubo", or octopus trap in Japan, where it was first described.The cause appears to involve high circulating levels of catecholamines (mainly adrenaline/epinephrine). Evaluation of individuals with takotsubo cardiomyopathy typically includes a coronary angiogram, which will not reveal any significant blockages that would cause the left ventricular dysfunction. Provided that the individual survives their initial presentation, the left ventricular function improves within 2 months. Takotsubo cardiomyopathy is more commonly seen in post-menopausal women.Often there is a history of a recent severe emotional or physical stress.

Contents 1 Etiology 2 Diagnosis 3 Histology 4 Treatment 5 Prognosis 6 Statistical analysis 7 Gallery

 Etiology

The etiology of takotsubo cardiomyopathy is not fully understood, but several mechanisms have been proposed.

1. Wraparound LAD: The left anterior descending artery (LAD) supplies the anterior wall of the left ventricle in the majority of patients. If this artery also wraps around the apex of the heart, it may be responsible for blood supply to the apex and the inferior wall of the heart. Some researchers have noted a correlation between takotsubo and this type of LAD.Other researchers have shown that this anatomical variant is not common enough to explain takotsubo cardiomyopathy. This theory would also not explain documented variants where the midventricular walls or base of the heart does not contract (akinesis).
2. Transient Vasospasm: Some of the original researchers of takotsubo suggested that multiple simultaneous spasms of coronary arteries could cause enough loss of blood flow to cause transient stunning of the myocardium.Other researchers have shown that vasospasm is much less common than initially thought.It has also been noted that when there are vasospasms, even in multiple arteries, that they do not correlate with the areas of myocardium that are not contracting.
3. Microvascular Dysfunction: The theory gaining the most traction is that there is dysfunction of the coronary arteries at the level where they are no longer visible by coronary angiography. This could include microvascular vasospasm, however it may well also have some similarities to the diseases such as diabetes mellitus. In such disease conditions the microvascular arteries fail to provide adequate oxygen to the myocardium.

It is likely that there are multiple factors at play which could include some amount of vasospasm, failure of the microvasculature, and an abnormal response to catecholamines (such as epinephrine and norepinephrine, released in response to stress).Case series looking at large groups of patients report that some patients develop takotsubo cardiomyopathy after an emotional stress or, while others have a preceding clinical stressor (such as an asthma attack or sudden illness). Roughly one third of patients have no preceding stressful event.A recent large case series from Europe found that takotsubo was slightly more frequent during the winter season. This may be related to two different possible/suspected pathophysiological causes: coronary spasms of microvessels, which are more prevalent in cold weather, and viral infections – such as Parvovirus B19 – which occur more frequently during the winter season.

 Diagnosis

Transient apical ballooning syndrome or takotsubo cardiomyopathy is found in 1.7–2.2% of patients presenting with acute coronary syndrome.While the original case reports reported on individuals in Japan, takotsubo cardiomyopathy has been noted more recently in the United States and Western Europe. It is likely that the syndrome went previously undiagnosed before it was described in detail in the Japanese literature.
The diagnosis of takotsubo cardiomyopathy may be difficult upon presentation. The ECG findings are often confused with those found during an acute anterior wall myocardial infarction. It classically mimics ST-segment elevation myocardial infarction, and is characterised by acute onset of transient ventricular apical wall motion abnormalities (ballooning) accompanied by chest pain, dyspnea, ST-segment elevation, T-wave inversion or QT-interval prolongation on ECG. Elevation of myocardial enzymes is moderate at worst and there is absence of significant coronary artery disease.
The diagnosis is made by the pathognomic wall motion abnormalities, in which the base of the left ventricle is contracting normally or are hyperkinetic while the remainder of the left ventricle is akinetic or dyskinetic. This is accompanied by the lack of significant coronary artery disease that would explain the wall motion abnormalities. Although, apical ballooning has been classically described as the angiographic manifestation of takotsubo, it has been shown that left ventricular dysfunction in this syndrome includes not only the classic apical ballooning, but also different angiographic morphologies such as mid-ventricular ballooning and rarely local ballooning of other segments.
The ballooning patterns were classified by Shimizu et al. as takotsubo type for apical akinesia and basal hyperkinesia, reverse takotsubo for basal akinesia and apical hyperkinesia, mid-ventricular type for mid-ventricular ballooning accompanied by basal and apical hyperkinesia and localised type for any other segmental left ventricular ballooning with clinical characteristics of takotsubo-like left ventricular dysfunction.

 Histology

Focal myocytolysis is reported as an origin of this cardiomyopathy. No microbiological agent has been associated so far with takotsubo cardiomyopathy. Kloner et al. reported that a pathologic change in the myocardium was not demonstrated in the stunned myocardium. Infiltration of small mononuclear cells has been documented in some cases; these pathologic findings suggest that this cardiomyopathy is a kind of inflammatory heart disease, but not a coronary heart disease. There is also a report describing histologic myocardial damage without coronary heart disease.

Treatment

The treatment of takotsubo cardiomyopathy is generally supportive in nature. In individuals with hypotension, support with inotropic agents or an intra-aortic balloon pump have been used. In many individuals, left ventricular function normalizes within 2 months.Aspirin and other heart drugs also appear to help in the treatment of this disease, even in extreme cases.

 Prognosis

Despite the grave initial presentation in some of the patients, most of the patients survive the initial acute event, with a very low rate of in-hospital mortality or complications. The patients are expecting a favorable outcome once recovering from the acute stage of the syndrome, and the long-term prognosis is excellent. Even when ventricular systolic function is heavily compromised at presentation, it typically improves within the first few days and normalises within the first few months.Although infrequent, recurrence of the syndrome has been reported and seems to be associated with the nature of the trigger.

 Statistical analysis

The increased awareness of this syndrome led life insurers to analyse mortality rates in general. In a March 2008 study, Jaap Spreeuw and Xu Wang of the Cass Business School observed that in the year following a loved one’s death, women were more than twice as likely to die than normal, and men more than six times as likely.The broken heart syndrome also led financial analyst David X. Li to develop the Gaussian copula models for the pricing of collateralized debt obligations where at times seemingly unrelated entities become subject to sympathetic financial defaults based on common (but at times not obvious) links. Gallery

Left ventriculography during systole showing apical ballooning akinesis with basal hyperkinesis in a characteristic takotsubo ventricle.

 

Scorpions

When Love Kills Love

Scorpions

When love kills love
Suddenly I think I always knew
I had my share of mistakes made quite a few
Finally I know when that's for sure
I don't look back in anger anymore
Suddenly the sun comes up again
There's a new beginning when we pass the end
Finally I know when that's for sure
I don't look back in anger anymore
When love kills love
Will someone rescue me
When love kills love
It's cutting through so deep
Suddenly I wake up from a dream
Someone tells me I've been talking in my sleep
Finally I know when that's for sure
I don't believe in daydreams anymore
When love kills love
Will someone rescue me
When love kills love
It's cutting through so deep
Well life goes round
and upside down
it's pretty mad
When love kills love
Will someone set me free
When love kills love
It's cutting through so deep
How can we choose when all we loose is all we have
(solo)
We run away from all the pain
When love kills love
Will someone rescue me
When love kills love
It's cutting through so deep
When love kills love