Tag: heart disease

A recent newspaper report said, “Two days after fourth-grade teacher Irma Garcia was killed in the Uvalde, Texas school shooting, her husband, Joe Garcia, suddenly died as well. Family members attributed his death to a broken heart.”

Broken heart syndrome mimics a heart attack. The exact cause of broken heart syndrome is unclear. It’s thought that a surge of stress hormones, such as adrenaline, might temporarily damage the hearts of some people. This happens after an extreme stressful event.

A person has no previous history of heart problems or coronary artery disease. That is coronaries are not plugged with atherosclerosis.

Broken heart syndrome may also be called: stress cardiomyopathy, Takotsubo cardiomyopathy, or apical ballooning syndrome.

Incidence of heart attacks caused by broken heart syndrome is around two per cent. Around one percent of people with broken heart syndrome ultimately die of it.

What are the risk factors for broken heart syndrome?

People who have anxiety or depression may have a higher risk of broken heart syndrome. Intense physical or emotional event is usually a precipitating factor. Anything that causes a strong emotional response, such as a death or other loss, or a strong argument may trigger this condition.

Chronic stress is another risk factor. Taking steps to manage emotional stress can improve heart health and may help prevent broken heart syndrome.

The condition is most common among women ages 50 and up. Women represented around 88 per cent of cases of broken heart syndrome (Journal of the American Heart Association Oct 13, 2021). An article in Cureus. (2020 Sep) also found that anxiety disorders were more prevalent in patients with broken heart syndrome than among healthy people.

How do you know you have broken heart syndrome?

Individuals with broken heart syndrome have signs and symptoms that mimic a heart attack and may include chest pain, shortness of breath and/or irregular pulse rate should seek immediate help and call 911. Take these symptoms seriously. Especially, if something like this happens after a stressful event like death in the family or a heated argument.

Anger, loneliness and depression

There is no doubt your emotions have significant effect on your heart. Managing your emotions will save your life.

Cardiac psychology is receiving attention from experts as a new emotion-based approach to heart health. It is important to treat the mind to improve the heart with a particular emphasis on achieving optimal quality of life outcomes.

There are many things you can do at home to take care of your heart and mind. When you feel angry, shut your eyes and meditate for a few minutes or go for a walk. Follow these five principals:

1. Avoid loneliness.
2. Enjoy life and find humour around you.
3. Follow Mediterranean diet. Generally considered to be world’s healthiest diet.
4. Keep moving – motion is lotion. Exercise regularly.
5. Have a positive outlook. Positive outlook equals longer healthy life.

Finally, I will quote what Dr. Ankul Kalra, MD said, “Self-care is extremely important when times are stressful.”

Managing your emotions will save your life.

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Recently, a relative of mine died. She had shortness of breath. She went to ER and was admitted to a hospital. She was investigated. After a week of investigations, she underwent coronary angioplasty for a narrow coronary artery. Two days later she was discharged. She went home and within an hour she fainted and died. That was sudden and tragic.

Statistics show one in 20 patients with unexplained shortness of breath in the primary care setting will have heart failure as its cause.

Statistics also show 38 per cent of patients with unexplained shortness of breath do not receive a definitive diagnosis within six months post-referral.

When a person presents with shortness of breath, the clinician has to determine whether it is due to cardiac (heart failure) or pulmonary cause.

Heart failure – also known as congestive heart failure – occurs when the heart muscle doesn’t pump blood as well as it should. When this happens, blood often backs up and fluid can build up in the lungs, causing shortness of breath.

What causes heart failure?

Common causes of heart failure are coronary artery disease, heart valve disease, high blood pressure and cardiomyopathy. If you’ve been diagnosed with one of these conditions, it’s critical that you manage it carefully to help prevent the onset of heart failure.

How would you know you are in heart failure?

Swelling of the feet and ankles, shortness of breath, fatigue, abdominal fullness due to swelling and distention of the liver are early manifestation of heart failure.

If you have these symptoms, you should see your doctor immediately. The doctor will order investigations which will include: blood tests, chest x-ray, echocardiogram, stress test, CT scan, MRI, coronary angiogram etc.

Some doctors rely mostly on NT-proBNP testing to monitor patients with heart failure. You do not need to fast or do anything to prepare for the test. Levels go up when heart failure develops or gets worse, and levels go down when heart failure is stable. In most cases, BNP and NT-proBNP levels are higher in patients with heart failure than people who have normal heart function.

The result helps your doctor determine if you have heart failure, if worsening fatigue or shortness of breath are due to heart failure or another problem or if heart failure has progressed toward end-of-life. It is important to note that this test is only one method your doctor uses to monitor your condition. Based on your results, your doctor can choose the best treatment plan for you.

Sixty-seven per cent of patients with unexplained shortness of breath did not need further diagnostic work-up after taking NT-proBNP test. A very useful test for patients with chronic unexplained shortness of breath.

The Canadian Cardiovascular Society recommends NT-proBNP screening to help confirm or rule out heart failure in patients with shortness of breath when clinical diagnosis remains uncertain. This can aid in decision-making and accelerate the pathway to appropriate referral.

In Alberta, Laboratory Services has offered B-type natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP) testing in hospital laboratories across the province since 2012. Emergency Department physicians and cardiologists are able to order these tests to assist with diagnosing and treating heart failure. This test has improved quality of referrals to cardiologists and has reduced diagnostic delays.

Treatment for heart failure:

For most people, heart failure is a long-term condition that can’t be cured. But treatment can help keep the symptoms under control, possibly for many years.

The main treatments are: healthy lifestyle changes, medications, devices implanted in your chest to control your heart rhythm, and surgery. Treatment will usually need to continue for the rest of your life.

The life expectancy for congestive heart failure depends on the cause of heart failure, its severity, and other underlying medical conditions. In general, about half of all people diagnosed with congestive heart failure will survive five years. About 30 per cent will survive for 10 years.

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Acute coronary syndrome is a medical emergency.

Acute coronary syndrome is a term used to describe a range of conditions associated with sudden, reduced blood flow to the heart. Part of the heart muscle is unable to function properly or dies. It is critical to make an early diagnosis.

The problem is, not all chest pain patients get investigated because the presentation of symptoms can be short term, intermittent or not very clear. Just like not all patients with headache get a CT scan of the head. Because not every person with a headache has a brain tumour. That is why many brain tumours are diagnosed late.

“Diagnosing a patient presenting with chest discomfort or pain remains a challenge for physicians despite advances in diagnostic testing, clinical practice guidelines, and enhanced understanding of acute coronary syndrome (ACS),” says the Canadian Medical Protective Association (CMPA) in their newsletter (December 2019).

CMPA suggests appropriate triage and testing, as guided by symptoms and patient risk factors. This may help improve the timely diagnosis of ACS. Basically, no chest pain should be ignored irrespective of age or sex of the patient.

What is acute coronary syndrome?

Acute Coronary Syndrome is a name given to three types of coronary artery diseases that are associated with sudden rupture of plaque inside the coronary artery. One such condition is a heart attack (myocardial infarction) — when cell death results in damaged or destroyed heart tissue. Angina and heart attacks are types of acute coronary syndrome.

Acute coronary syndrome often causes severe chest pain or discomfort. It is a medical emergency that requires prompt diagnosis and care. The goals of treatment include improving blood flow to the heart, treating complications and preventing future problems.

Chest pain or discomfort is the most common symptom. However, in some patients’ signs and symptoms may vary significantly depending on patient’s age, sex and other medical conditions.

If you are a woman, older adult or have diabetes then you are more likely to have signs and symptoms without chest pain or discomfort. That is one of the reasons why a correct diagnosis is missed.

CMPA says, “Consistent with the medical literature, risk factors for women also displayed gender-specific characteristics, such as menopause and pregnancy, and women frequently presented with atypical chest pain.”

The signs and symptoms of ACS usually begin abruptly. They include: Chest pain (angina) or discomfort, often described as aching, pressure, tightness or burning. Pain spreading from the chest to the shoulders, arms, upper abdomen, back, neck or jaw.

Early diagnosis is important. When someone is rushed to the emergency room with chest pain, testing must be performed to determine whether or not a person’s signs and symptoms are due to a heart attack or to another cause. The doctor will order a blood test to see if there is evidence that heart cells are dying and order ECG to check for the heart’s electrical activity.

Initially, if the tests are normal then serial testing (ECG and cardiac enzymes) should be done to check for any changes. Mistakes occur if there is failure to consider cardiac risk factors in the diagnosis of unexplained chest discomfort or pain. Especially in female patients.

In conclusion, managing acute coronary syndrome is a relatively common and challenging task, says CMPA. Patient’s risk factors should be considered along with appropriate serial blood testing in the emergency department. This can contribute to safer patient care, says CMPA.

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