'Died of a broken heart': Can it really happen?

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Joe Garcia, whose wife Irma Garcia was among the 21 people killed in the Texas school shooting this week, died minutes after returning home from a memorial, in what the family has described as a broken heart.

“I truly believe Joe died of a broken heart and losing the love of his life of more than 25 years was too much to bear,” Debra Austin, Irma’s cousin, wrote in a post for a GoFundMe campaign for the family.

While Joe Garcia’s death has been described as a heart attack by family members on social media, Takotsubo cardiomyopathy, more commonly known as “broken heart syndrome” or stress-induced cardiomyopathy, is actually different. Sometimes called apical ballooning syndrome, it is an actual medical condition triggered by severe emotional or physical stress, according to Harvard Medical School, John Hopkins Medicine, the American Heart Association, and Dr. Katie Connolly, a cardiologist and heart failure specialist who spoke with CTVNews.ca.

“Ultimately, it's obviously a horribly tragic situation. In the best of times, with all the best information, it can be hard to differentiate if this is Takotsubo versus a heart attack,” Connolly, who is also an assistant professor of medicine at McMaster University, said in a phone interview on Friday. An autopsy would be required to determine the actual cause, she said.

“Both scenarios are plausible … Obviously the timing can’t be ignored and he was another victim of this horrible scenario.”

WHAT TRIGGERS IT?

Researchers have looked at the way grief and stress can manifest itself in physical ways, including an increased risk of mortality, hair loss, skin problems, and sleep issues. One recent study out of Germany suggests that happy and joyful life events can, in rare instances, also trigger the syndrome.

The general link between stress and the increased risk of cardiovascular disease is also well documented. Severe stress can be triggered by a sudden or serious illness, surgery, or major accident, the unexpected death of a loved one, extreme anger or fear, financial loss, a sudden surprise, or other intense emotional or physical experiences.

“When you have a patient that’s not deceased, it can be very hard to tease out if it’s a heart attack or if it’s Takotsubo. Certainly, either a true heart attack or this condition called Takotsubo could be triggered by a very stressful life event,” said Connolly.

The syndrome was previously thought to be fairly rare, “but two or three per cent of presentations that look like a heart attack are actually Takotsubo, so it’s actually probably not as uncommon as once thought,” she added.

WHAT HAPPENS?

While the exact cause is not fully clear, experts believe that surging stress hormones can overwhelm or "stun" the heart muscle, triggering a change in the cardiac cells and blood vessels that disrupts the heart function, inhibiting the left ventricle from pumping efficiently and effectively. The left ventricle is the thickest and hardest working of the four chambers in the heart, and responsible for getting oxygenated blood to the entire body.

“The most common abnormality in takotsubo cardiomyopathy — the one that gives the disorder its name — is ballooning of the lower part of the left ventricle. During contraction, this bulging ventricle resembles a tako-tsubo, a pot used by Japanese fishermen to trap octopuses,” according to Harvard.

Data suggests that it is more common among women than men, with the risk increasing by five times after menopause. The physiology of why that is, however, is not entirely clear, Connolly said. There may be some role involving lower levels of estrogen, which has protective effects on the heart, she explained.

WHAT ARE THE SYMPTOMS?

There is a wide spectrum of severity, according to Connolly.

“There’s a big range — from mild chest pain or trouble breathing, which would be very common symptoms, to significant dysfunction of the heart or even dangerous arrhythmias where the heart goes too fast,” she said.

Severe or fatal cases of cardiac arrest resulting from insufficient blood coming out of the heart make up a small percentage of incidences.

Sweating and dizziness can also be present. Symptoms are overall similar to those of a heart attack and imaging studies and other diagnostic measures are required to distinguish the cause. Unlike a heart attack, Takotsubo cardiomyopathy is not caused by blocked coronary arteries. Instead, tests will show abnormal changes to the left ventricle and the ballooning effect that gives the condition its name.

It can be life threatening and in some instances can result in congestive heart failure, low blood pressure, and other potentially life-threatening heart rhythm abnormalities.

CAN IT BE TREATED?

The condition is not always fatal and most abnormalities usually clear up within days or a few weeks, with no lasting scar tissue or damage. In some cases, patients can exhibit ongoing heart issues.

There is no typical treatment for the underlying problem, but heart failure medications like beta blockers, ACE inhibitors and diuretics are often prescribed to help treat the specific manifestations or consequences of the condition. Beta blockers, for example, can help reduce the impact of stress hormones like adrenaline.

Some advise reducing stress levels or avoiding stressful situations if possible and recommend activities such as exercise or meditation. Always consult with your doctor to have any potential concerns properly evaluated.