STRESS CARDIOMYOPATHY/ TAKOTSUBO
Stress can affect many parts of the body including the heart. Under stress, the body reacts by releasing adrenaline. This is the ‘fight or flight’ mechanism. The body can not tell what the stress is- whether the house is on fire, you have just lost your job, your kid has run away or a tiger is chasing you! But the response is the same. Adrenaline bombards the heart. There are many receptors on the heart that adrenaline attaches to and cause the heart to beat faster- so you can run faster! This adrenaline also negatively affects the heart. Over a short time, the heart actually starts to change shape. This is called ‘remodeling’. The left ventricle balloons out.
Takotsubo affects around 2% of acute patients. Primarily affecting women, usually, after menopause, this usually occurs under severe emotional distress and is also called the ‘broken heart syndrome’. Symptoms mimic a heart attack with chest pain and changes on the ECG and lab. When presenting to the ER the pt is often taken to the catheterization lab to see if there is a clogged coronary artery but they are usually open. Symptoms can often be quite dramatic with the patient in shock. With hospital support, there is usually a low death rate. The treatment is Beta-blockers, ACE inhibitors, statins, and an antiplatelet agent. Recovery is quite good with treatment. We have seen an uptick of this related to stress due to COVID-19.
“Takotsubo Cardiomyopathy” was first described in Japan in 1990 and in the United States in 1998. It was named after an octopus trap (“tako-tsubo”) due to the shape of the trap being similar to the appearance of the left ventricular (LV) apical ballooning that occurs in this condition.” Salim Rezaie, MD, July 11, 2013, Takotsubo Cardiomyopathy: The Octopus Trap
INFLAMMATORY CARDIOMYOPATHY/ MYOCARDITIS
Viral infections are the most common sources of inflammation of the heart. This can follow infection in the lungs such as an upper respiratory infection, the flu, polio, rubella (mumps), Lyme disease, COVID, or Coxsackie Disease (hand-foot-mouth disease- a common viral disease). Coxsackie B3 virus can cause viral myocarditis which causes inflammation of the heart resulting in heart failure. It is a common virus that lives in the GI tract. It is very contagious. Frequent handwashing and not sharing towels with an infected person is important. Coxsackie B viruses are estimated to be responsible for at least 50% of the cases of infection caused heart diseases. It mainly occurs in middle-aged men around 42 yo for unknown reasons. There is a 20% risk of recurrence and permanent heart damage. This virus can be found in children and passed onto their caregivers. The lesions may occur in the mouth, soles of feet and palms of hands as blisters or pink or red spots and bumps and may occur anywhere on the body.
Symptoms are similar to the flu with fever, abdominal pain, diarrhea, muscle aches and pain, headache, malaise, in addition to chest pain. As the virus escapes the GI tract and invades the heart the body’s own immune system is alerted and starts to fight the virus. This affects the normal heart cells as well as the infected cells in the heart. Severe fatigue follows as the heart is affected. In most cases, the disease goes away on its own without treatment although lingering heart damage may have occurred. Arrhythmias ( bad rhythms in the heart) can occur and the heart can become weaker and weaker requiring heart transplantation. The virus may be gone but the immune system continues to damage the heart.
Treatment is the same as other types of heart failure: exercise, medications, and symptom management.
The HF classes sponsored by SDCA are still on hold. Continue to check periodically for dates which we may restart the classes.
As with any health concerns, your specific treatment program should be discussed thoroughly with your primary care physician as well as any specialists who may need to be consulted – like a cardiologist.