We often talk about heartbreak, but rarely do we realize that it can literally happen. Broken heart syndrome is a medical condition that can present itself acutely and manifest itself in serious heart complaints. The picture resembles a heart attack, but is slightly different — and is often only recognized as such later.
Cardiologist Menno Baars, co-founder of HartKliniek, is familiar with the syndrome. “It has to do with stress on the heart,” he says. We asked him more about broken heart syndrome.
What stress does to the heart
‘The heart is sensitive to stress,’ explains Menno Baars. ‘When stressed, adrenaline-like hormones are released. This not only happens with acute, intense emotions, but also with long-term, chronic stress. And these hormonal changes can cause the heart’s contractile force to decrease.’
That mechanism has long been underestimated, says Menno Baars: ‘Cardio muscle cells are much more sensitive to this than we initially thought.’ Under the influence of stress, the heart even changes shape. Normally the heart has a cone shape, but in broken heart syndrome it gradually deforms. ‘It takes on a strange shape: very slim in the middle and very rounded at the tip,’ he says.
That shape reminded doctors of a Japanese fishing net, a takotsubo. ‘One of those landing nets where fish can no longer come out. Hence the name.’ This deformation causes the heart to pump blood less efficiently, causing symptoms of heart failure.
Difference with a heart attack
The tricky part is that broken heart syndrome presents much the same as a classic heart attack. “The ambulance cannot make that distinction,” says Menno Baars. An ECG also does not provide a definitive answer. ‘On the ECG you see an image that looks very much like an acute myocardial infarction.’
The complaints are severe. ‘Severe shortness of breath, weakness, sometimes a real feeling of suffocation. It can occur suddenly, but can also creep in slowly. People call 112, the ambulance makes an ECG, which looks like an infarction, and they go to the hospital with sirens screaming,” he explains.
And that is right. ‘The image can be fatal if adequate action is not taken.’ At the same time, Menno Baars also sees hopeful aspects: ‘In general, we see good recovery of the pumping function of the heart, if you treat it well.’
Treatment: rest for the heart
The first step is the correct diagnosis. ‘A heart attack is different from a takotsubo,’ emphasizes Menno Baars. ‘If it is not an infarction but a stress heart, a fear heart, then the treatment is comparable to that of heart failure.’
Heart failure means that the heart has become overtired and can no longer pump properly. ‘The heart is a muscle. If it weakens, it works less well,” he says. ‘Luckily there are effective medicines. They relieve the heart, ensure that it calms down a bit and doesn’t have to work as hard.’
This also includes lifestyle advice, namely taking it easy and avoiding strenuous exercise for a while. Menno Baars likes to use an image: ‘If a car is broken down and has to go to the garage, you don’t go full throttle. Then you quietly drive thirty. That’s how you should deal with your heart.’ Recovery must then be closely monitored, and according to Menno this can only be done with an ultrasound of the heart.
Who is most at risk?
Important to know: this form of heart failure is rare and occurs much more often in women than in men. About 90 percent of patients with this syndrome are postmenopausal women, JAN reads on the HartKliniek website.
Furthermore, not everyone gets a broken heart when stressed. ‘It also has to do with how you deal with stress in your life,’ says Baars. ‘Some people can handle this well, others are more sensitive to stress.’
We don’t yet know exactly why this is the case. ‘Sometimes it has to do with what you have already experienced. People who have experienced a lot of misery and misery from an early age are often more vulnerable.’
Menno Baars compares stress to a bucket under a dripping tap. ‘That bucket can collect drops for years. But at a certain point it is full to the brim. And then all it takes is one more drop and it will overflow.’
A society under pressure
According to him, society also plays a role. ‘We have to perform enormously in the Netherlands. A lot is expected of you from the moment you are born. There is a lot of social pressure on our backs,” he explains. According to him, this also explains why we like to go abroad so much: ‘Not just for the sun, but because life there often feels less hectic.’
He argues for more attention to prevention. ‘Politicians and health insurers should focus much more on de-stressing people,’ he says. At the same time, he sees positive developments. ‘The fact that men nowadays get weeks off when a child is born is a real benefit. In the past, it was time to move on to fields again after two days.’
Can you see it coming?
‘Sometimes. It is often a gentle slope upwards, and then suddenly an acceleration. You can intervene in that first phase. If you recognize that, you can avert it,” he explains.
This is not possible with acute emotional stress – such as sudden loss. ‘Those are unimaginable moments, and they can lead to a takotsubo. But with chronic stress there are signs: increasing shortness of breath, fluid retention in the legs or ankles, and no longer being able to cope with exertion. If you can no longer keep up with your peers while walking, then something is wrong,’ says Baars.
The prognosis: usually good, provided you cooperate
The good news? ‘If you catch it on time and are treated well, we almost always see a recovery of pumping power. But there is a condition for this, you must be able to avoid that stress. Recovery requires efforts from both sides.’
Our expert and cardiologist Menno Baars is co-founder of De HartKliniek. This clinic specializes in the female heart and currently has sixteen locations throughout the Netherlands. The care is accessible to everyone with reimbursement from the health insurer.