Broken Heart Syndrome” or Takotsubo Heart Disease, is a temporary acute stress induced Heart failure, which mimics the presentation of a heart attack.
A recent study in JAHA found that Broken Heart Syndrome is more prevalent in patients with malignancy and immediate recognition is essential since the syndrome may have negative long term prognosis in this patient population Journal of American Heart Association
Diagnosis and treatment of Takotsubo Heart Disease
Chest pain , shortness of breath
Abnormal cardiac enzymes , used to diagnose a heart attack
Abnormal EKG
Signs of heart failure and the typical ” octopus trap vase” appearance on the Echocardiography
An angiogram will reveal a clot and cholesterol plaque blockage in heart attack but no abnormalities , or ” clean arteries ”
Heart failure and symptoms improve even without treatment in less than a month in most cases
Prognosis is excellent , withcomplete resolution of heart failure in less than a month , with standard treatment for heart failure .
If malignancy is present , the following risk factors are associated with negative prognosis
Age >70
Atrial fibrillation
Peak troponin >10x upper limit of the normal (ULN)
Peak creatinine kinase >10x ULN
Left ventricular ejection fraction <45%
Malignancy, neurologic conditions, and psychiatric disorders
Take home message
Consider malignancy in patients with Broken Heart Syndrome
If cancer is present , consider longer treatment of heart failure with the possibility of incomplete recovery of heart muscle
