Chest pain, an octopus and a broken heart

In 1990, Japanese researchers identified a temporary condition in which patients experienced the same symptoms as a heart attack, including chest pain and shortness of breath, but tests turned up no evidence of blockages even though the patients’ electrocardiograms mimicked the abnormalities seen in heart attacks. Even more bizarre, doctors noticed that these patients each experienced ballooning of their left ventricles, the heart’s main pumping chamber, following a particularly stressful event, such as the death of a loved one, a natural disaster or a sudden illness. Researchers named the disorder “takotsubo cardiomyopathy” because of the pot-like shape formed by the left ventricle resembling tako tsubo, a type of Japanese octopus trap. In the United States, doctors refer to this condition as “broken heart syndrome.”

It’s well documented that stress can wreak havoc on a human body, causing headaches, fatigue, chronic pain and an upset stomach.  Few people realize that, in rare circumstances, severe emotional trauma can actually cause a broken heart. Broken heart syndrome primarily strikes women between the ages of 58 and 75 — women like 62-year-old Joanie Simpson of Anahuac, Texas.

Joanie and her husband, Benny, had purchased an old trailer and planned to spruce it up for retirement, but the job became bigger and more expensive than either one of them had anticipated. When they tried to offload it to a buyer, the money was slow to come, straining the couple’s finances and putting Joanie and her heart under a lot of stress.

Another stressful setback occurred when their son-in-law lost his job. That stress was compounded when they discovered that their son needed back surgery. “It just seemed like one thing after another,” Joanie said.

But the final straw was the death of the beloved family dog, Meja, a 9-year-old Yorkie who had been struggling with a chronic lung disease. The veterinarian had urged the couple to put the dog down, but Joanie had resisted since Meja still seemed so happy and full of energy.

One week after that veterinarian visit, Meja’s condition suddenly worsened and Joanie found herself sitting helpless at Meja’s side in her final moments, wishing she had heeded the doctor’s advice.

“It was honestly one of the most horrible things I’ve ever had to go through,” Joanie later said, as she choked back tears. “I was just devastated.”

To say that Joanie’s heart was broken after Meja’s death would be an understatement. The little Yorkie had been a part of Joanie’s family for eight years, helping her and Benny cope with an empty nest, entertaining them with her antics with the garden hose and riding shotgun on trips to New Orleans in the cab of their pickup. Joanie could hardly bear the pain of losing Meja.

Not long after they buried Meja in their backyard, Joanie awoke one morning with a terrible bout of back pain. When she turned to her side, the pain spread to her chest. “I used to do medical transcription for doctors, so I was familiar with the symptoms of a heart attack,” she said. “I yelled for my husband to take me to the hospital right away.”

At her local community hospital, all tests showed that she was in the throes of a severe heart attack. Joanie was given a nitroglycerin tablet to treat her chest pain and the hospital staff called Memorial Hermann Life Flight® to transport her to the Texas Medical Center for more intensive treatment.

“I was starting to get really scared when they called Life Flight, but on the helicopter, the male nurse riding at my side was so sweet and kind, and provided such reassurance,” she said. “Those people are saints. I knew I was going to be OK.”

Although her echocardiogram indicated that Joanie’s heart was in distress, a coronary angiogram procedure performed at Memorial Hermann Heart & Vascular Institute-Texas Medical Center (HVI) was unable to detect any blockages in her arteries. Much to Joanie’s surprise, she was not, in fact, having a heart attack.

Dr. Abhijeet Dhoble, cardiovascular disease specialist at Memorial Hermann Heart & Vascular Institute and McGovern Medical School at UTHealth, had another suspicion that was confirmed when an echocardiogram of Joanie’s heart showed that her left ventricle had contorted into the shape of a flat-bottomed pot, similar to a Japanese octopus trap. Dr. Dhoble discovered that she had suffered broken heart syndrome, one of only a handful of cases he has seen in his career.

“What’s interesting about broken heart syndrome is that it’s virtually indistinguishable from a true heart attack in clinical presentation,” Dr. Dhoble said.

Because the condition is relatively new and not well understood by many doctors, as many as 5 percent of women diagnosed with heart attacks may actually have takotsubo cardiomyopathy. Although fatal in rare cases, the disorder is usually treatable, with most people making a full recovery within a month.

“The good news is that this condition is completely reversible in most cases with supportive care,” Dr. Dhoble said.

It was the best news Joanie could have received. Within two days, she was discharged from the hospital with a prescription for rest and relaxation. She said she’s grateful that Dr. Dhoble and his staff at the Institute had the expertise to properly diagnose her condition, and she feels blessed that her bad situation had a happy ending. Today, she’s found health and happiness as she starts a new life with Benny in rural West Texas. “I’ve been given a new lease on life, and I’m trying to take advantage of that,” she said. “I exercise more. I eat better. I try to take care of myself. God didn’t promise us that life was going to be a bowl full of cherries, but this is a beautiful world, and I get to keep living in it.”

To learn more about keeping your heart healthy, visit our Heart Month page.

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