Increase in broken heart syndrome due to COVID-19 pandemic

Increase in broken heart syndrome due to COVID-19 pandemic

Cleveland Clinic researchers have found a significant increase in patients with stress cardiomyopathy, also known as broken heart syndrome, during the COVID-19 pandemic.

Stress cardiomyopathy occurs in response to physical or emotional stress and causes dysfunction or failure in the heart muscle. Patients typically experience symptoms similar to a heart attack, such as chest pain and shortness of breath, but usually do not have acutely blocked coronary arteries. However, the left ventricle of the heart may show enlargement. Other symptoms include irregular heartbeat, fainting, low blood pressure, and cardiogenic shock (an inability of the heart to pump enough blood to meet the body's demands due to the influence of stress hormones on the heart's cells).

The COVID-19 pandemic has stressed people's lives on multiple levels

"The COVID-19 pandemic has created multiple stresses in people's lives across the country and around the world. People are not only worried about themselves or their families, but are also dealing with economic and emotional issues, societal issues and potential loneliness and isolation," said Dr. Ankur Kalra, a cardiologist at Cleveland Clinic in Invasive and Interventional Cardiology and Regional Cardiovascular Medicine, who led the study. “Stress can have physical effects on our bodies and hearts, as shown by the increasing diagnosis of stress cardiomyopathy.”

The causes of stress cardiomyopathy

The causes of stress cardiomyopathy, also known as Takotsubo cardiomyopathy, are not fully understood. However, doctors believe that a person's response to physically or emotionally stressful events causes a release of stress hormones that temporarily reduce the heart's ability to pump - causing it to contract less efficiently or irregularly, rather than in a consistent, normal pattern.

Cardiologists examined 258 patients for this study

For the study, cardiologists examined 258 patients who came to the Cleveland Clinic and Cleveland Clinic Akron General between March 1 and April 30 with cardiac symptoms known as acute coronary syndrome (ACS) and compared them to four control groups of ACS patients before the pandemic. They found a significant increase in patients diagnosed with stress cardiomyopathy, reaching 7.8% compared to a prepandemic incidence of 1.7%. Patients with stress cardiomyopathy during the COVID-19 pandemic had a longer length of hospital stay than patients hospitalized in the pre-pandemic period. However, there was no significant difference in mortality between groups. All patients diagnosed with stress cardiomyopathy tested negative for COVID-19.

This study was published in JAMA Network Open

“As the pandemic continues to evolve, self-care is critical to our heart health and our overall health during this difficult time,” said Dr. Grant Reed, M.Sc., director of the Cleveland Clinic's ST-Elevation Myocardial Infarction (STEMI) program and senior author for the study. "For those who feel overwhelmed by stress, it is important to reach out to your doctor. Exercise, meditation, and staying in touch with family and friends while maintaining physical distance and safety measures can also help ease anxiety."

Patients with stress cardiomyopathy generally restore cardiac function and recover within a few days or weeks, although the condition can occasionally cause serious adverse cardiac and cerebrovascular events and rarely can be fatal. Stress cardiomyopathy is typically treated with heart medications to lower blood pressure and slow the heart rate. Other medications may be prescribed to help manage stress.

Researchers say more studies are needed in this area, particularly to determine whether this trend is present in other regions of the country.