Broken Heart Syndrome - Repost (Original Air Date: 3/2022)

Its symptoms are like those of a heart attack. We’re talking about the vulnerable heart, on this week's Ageless Glamour Girls Podcast. February is National Heart Month, and we're revisiting a popular and very important episode: “Broken Heart Syndrome.”  It first aired in March of 2022 - our debut season.  Broken Heart Syndrome can happen when you experience sudden acute stress. And get this - a study published last year, suggests cases of the condition are increasing in middle-aged and older women. The good news is that it’s treatable. The study's senior author, Dr. Susan Cheng of the Smidt Heart Institute at Cedars-Sinai in Los Angeles, joined us to discuss the findings and solutions.

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 GUEST: Dr. Susan Cheng
 BIO: Susan Cheng, MD, MMSc, MPH is the Erika J. Glazer Chair in Cardiovascular Health and Population Science, director of Cardiovascular Population Sciences, and director of Public Health Research in the Smidt Heart Institute at Cedars-Sinai. Dr. Cheng is a cardiologist, echocardiographer, and clinician-scientist who leads research programs aimed at uncovering the drivers of cardiovascular aging in women and men. 

She received her bachelor's degree from Harvard College, a medical degree from McMaster University, Master of Medical Science from MIT, and Master of Public Health from Harvard. Dr. Cheng completed Osler internal medicine training at the Johns Hopkins Hospital and cardiology training at the Brigham and Women's Hospital and Harvard Medical School, where she then served as cardiology faculty and associate director of the Cardiovascular Imaging Core Laboratory. She is co-director of the Framingham Heart Study Echocardiography Laboratory and co-director of the international Bioactive LipidsNet Consortium.

Dr. Cheng has served on the editorial boards of major cardiovascular and imaging journals as well as on leadership committees for the American Heart Association and American College of Cardiology. She has chaired and contributed to the American Heart Association's scientific statements on research methods, heart disease statistics, and the cardiovascular care of older adults. Dr. Cheng has authored over 350 publications and her work has been recognized with multiple awards and supported by continuous NIH funding.

https://researchers.cedars-sinai.edu/Susan.Cheng

Transcript

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SPEAKER_00 0:00

Hi, this is Marquita Curtis Haynes. I'm the host of the Ageless Glamour Girls podcast. As you likely know, February is National Heart Month. That said, I decided to repost a podcast from season one. Actually, it was my second episode. And it's all about the heart, specifically a condition called broken heart syndrome. And it's much bigger than what you might be thinking. Here now is that episode. Welcome to the Ageless Glamour Girls Podcast. I'm your host, Marquita Curtis Haynes, CEO and founder of the lifestyle brand Ageless Glamour Girls. This is Wellness Wednesday, and today on the show, we're talking the Vulnerable Heart. We're continuing Heart Health Month in February with a look at what's called Broken Heart Syndrome. I'll say it again, broken heart syndrome. Now many of us have experienced it, though you may not even know it. That's because, according to doctors, it's easy to miss. It can also be hard to identify. Yes, breaking up with someone, or worse, losing a loved one, can cause it, but that's not the only thing. And ladies, we're most at risk. A recent study from the Journal of the American Heart Association suggests that cases are rising in the U.S., especially among middle-aged women and older women, and the group van hit the hardest, women between the ages of 50 and 74. You may have noticed that bottom number coincides around the start of perimenopause. Just saying. All right, we went straight to the top for answers on this important health subject. We're talking to the study's senior Arthur. She's also director of public health research at Cedars Sinai's Smit Heart Institute in Los Angeles. Dr. Susan Ching, a cardiologist, welcome to the podcast. Thank you so much for having me. It's a pleasure to be here. Dr. Ching, exactly what is broken heart syndrome?

SPEAKER_01 2:02

It is a relatively under-recognized condition that, as you said, predominantly affects women more so than men, although men can still get it. And it's a syndrome that goes by many names. Some of the technical names that we have heard about. We look at the history of this syndrome and how it was first described, come from Japan, where Japanese cardiologists and researchers first identified it. So one of the names is called Takutsubo syndrome. Takutsubo, that word comes from the Japanese word for an octopus trap. An octopus trap is actually a ceramic or stone-made type of pot where the neck is a lot narrower than the base. And that's uh the idea is there's it catches the octopus, it goes inside in the sea and it can't get out because you know the the head is too big to get back out. And and the reason why this heart syndrome is called Takatsubo is because the shape of the heart when it's stunned in this particular syndrome looks like that octopus trap. And so that's one name for it. Another name for it is stress cardiomyopathy, because the primary driver of this that has classically been described is stress from any source emotional, psychological, physical, um, mechanical, um, biological, uh, any type of stress um can cause this syndrome.

SPEAKER_00 3:28

Wow, we're gonna get more into that in a minute, but first, uh that's so we can call it another form of heart failure, right?

SPEAKER_01 3:35

That's right. It is a form of heart failure. Traditionally, um or conventionally, we think of it as a transient or temporary form of heart failure. Um, in most cases, we fortunately see that the heart, although stunned when it first occurs and it first happens, and the heart muscle weakens and the heart failure symptoms said in. We see that in most cases over time, that tends to get better, tends to resolve. But we're still trying to learn, we're still doing research to try and understand the degree to which that might not happen as perfectly as we would like in all affected individuals.

SPEAKER_00 4:09

Okay, now let's get to the symptoms or warning signs. Um, because they might mimic a heart attack, but how do they differ from a heart attack? That's a great question.

SPEAKER_01 4:19

In in many cases, they can actually be very similar in heart disease apart. Um, in some of the classic um we uh described first examples, every sign and symptom pointed to what looked like um the patient or the affected person is having an actual heart attack. And so all the typical treatments and all the typical emergency procedures and protocols we put into place and put into action for this uh person looking like they're having an actual heart attack, the classic chest pain, the classic shortness of breath, uh perspiring, sweaty palms, sweaty, um, uh sweaty forehead, uh palpitations. And then finally, this person ends up in the catheterization lab, which is where we typically um take people to treat them if they're having in the middle of an acute um myocardial infarction, technical term for you know, but classic heart attack. And then lo and behold, the coronary arteries are all clear. So this really, and then that's when the diagnosis typically gets made. The the coronary arteries are clear, so it's not a garden variety heart attack, which is caused by cholesterol plaque rupture, a big clot forming in the coronary artery, blocking flow, and yet the heart function is stunned. We can actually look at that in the catheterization lab also. That's where the classic diagnosis are typically made because the symptoms can look very much like a classic heart attack. They can be hard to tease apart if you're not thinking about alternate causes that um that can also cause chest pain and shortness of breath.

SPEAKER_00 5:43

Right. Wow.

SPEAKER_01 5:44

And it can come on all of a sudden, right? Suddenly. That's exactly right. It typically comes on all of a sudden. Um, and in some cases, maybe there's some you know subtle warning signs, there, you know, some subtle cues that that this is happening. Um, but the the the most frequent uh presentation is uh sudden onset.

SPEAKER_00 6:02

Okay. Um now obviously if you suspect something, uh ladies, call your doctor immediately. As we mentioned earlier, that women make up a huge chunk of all cases. I read we're nearly 90%. I think it was 88% to be exact. But yet, again, it's hard to pinpoint exactly why. What's your take on that?

SPEAKER_01 6:22

That is the million-dollar question, which we knew. And that's actually why we're doing all this work, uh, this hard work. Not only is it something that um is underrecognized, so we need to do a better job recognizing it, it does predominantly uh affect women more than men at a ratio of you know, odds of you know, nine to one at least, if not more. And and so part of the challenge has been why? Try to find out why. And uh we think it has something to do with the fact that we're biologically different. So females are biologically different than males, chromosomally, we're different. Our hearts are shaped differently as we age, those differences and our heart anatomy, structure, and function also continue to differ. And then, of course, uh we have different hormones um that sort of um govern, you know, who we are uh biologically different as members of different sex. And and those things change over time. And there is this, as you mentioned, the perimenopausal transition. It's probably not the only explanation or even potentially the primary explanation, but it's probably one factor. Um, we're still trying to understand why. What are the mechanisms that lead the female heart to at a certain age be a lot more vulnerable to this particular stress-meted condition than the male heart of similar age?

SPEAKER_00 7:41

Wow. And you we keep going back to that same point stress, stress, stress. Um, let's look at some of the other risk factors like high cholesterol, I think, smoking, high blood pressure.

SPEAKER_01 7:51

That's right. We are trying to understand exactly what it is that makes a woman or man's heart vulnerable to the syndrome. Uh, that's different from the classic cardiovascular factors that makes the heart vulnerable to the more conventional types of heart disease. We are still working on that. We're still trying to understand what it is. We think maybe uh it has something to do with inflammation, maybe it has something to do with neurohormones or other types of hormones, not necessarily sex hormones, that make that heart muscle just more sensitive to stress. We do know that whatever it is, whatever it is, it has something to do with how that that particular affected individual's heart muscle and the cells that make up the heart muscle, for some reason are just more primed, more vulnerable to be affected by stress. And then what we mean by stress and the stress response is when you or I, you know, run to catch the bus or you know, get a um uh a stressful phone call or open the envelope and see a sort of a stressful bill or something in the mail. You know, the the stress hormones, the stress hormones go up. So I'm not talking about sex hormones now, I'm talking about stress hormones, and those are normal hormones that help us with the fight or fight response, which is part of all human nature and physiology. Adrenaline. Adrenaline helps us get up in the morning, adrenaline helps us, you know, run, catch that bus. Adrenaline helps us deal with, you know, traffic, really bad traffic when we're running late for work, adrenaline. So when adrenaline surges in the midst of or as a result of a major stressful event, that adrenaline surges throughout the whole body. And for some reason, in in individuals affected by broken heart syndrome, the heart muscle is very sensitive to that surge of adrenaline. And that's uh what leads to this condition affecting some people, and for some reason, not others. And that's the mystery.

SPEAKER_00 9:55

Wow. And as you you just alluded to, the emotional. We're talking the emotional, physical, environmental stresses, natural disasters. I mean, because it's called broken heart syndrome, people automatically think, oh, it's from a broken heart, literally, you know, from a broken heart. But no, we're talking about if you want through, you know, that you have a cancer diagnosis, job loss, exactly car accident, uh, even severe pain, right? Can lead to this.

SPEAKER_01 10:21

That's exactly right. I I can tell you that when I was a cardiology fellow at the Brigham Women's Hospital training to learn how to be a cardiology attending, I um was involved in a case of a young woman who was previously perfectly healthy and just happened to need to go in for an elective surgery um to remove some fibroids. It should have been routine in and out of surgery. And she wasn't even awake, she was under anesthesia, but her body experienced some such stress from the surgical procedure that her heart was affected. So she was trying to come as they were trying to get the team, was trying to get her out of the anesthesia in the postoperative recovery area, which really should have been a routine case. Her heart was so sensitive to the stress of the surgery that it started to uh fail, that it was stunned and was not pumping properly. And that's where we, as cardiologists, we're called in to make the diagnosis. So it can happen even when you're under general anesthesia or asleep, which is kind of amazing.

SPEAKER_00 11:18

That that's amazing. And you reminded me of the time years ago I was having knee pain, and I remember walking outside and the pain was so horrific. My heart started hurting. And I was like, Oh, check out that connection, right?

SPEAKER_01 11:33

Exactly. You know, you just you just you just hit the nail on the head. The brain-heart connection is really the center of all of this. You know, at the end of the day, you know, when my colleagues um, you know, who I work with on the type of work likes to say, you know, as cardiologists, we think the heart is the most important organ when it's it's really the brain. The brain controls everything. And so that the this is really the syndrome is really the prototypical, the exemplary example of how our brains are really connected to every single organ in our body, including our heart.

unknown 12:05

Wow.

SPEAKER_00 12:06

Wow. Well, for the most part, it's a temporary heart condition, even though I read that it, you know, in rare cases it can be fatal. But what's the recovery time for broken heart syndrome and and what are the treatments towards recovery?

SPEAKER_01 12:17

That's a that's a good question. So we we do believe that for the most part, in most cases, people recover their heart function, at least, you know, using the conventional ways that we can measure heart function. It can take days, it can take weeks, sometimes it can take months. Um, in most people, it's on the order of uh weeks to months. We can monitor the recovery of their function by taking moving pictures of the heart using ultrasound or other methods. And typically we say, you know, we really try to get the uh the situation where if we can identify where the stress source is, try to avoid that stress, address that stress, you know, get control of that stress. Um, in situations where it's not easy to identify the source and or manage the source of stress, um, we will prescribe something called a beta blocker, which is a medication that helps to blunt the receptors on the heart that are uh susceptible or vulnerable to that adrenaline, to the to the stress hormones. And so we'll really try to keep the heart protected, relaxed, and we will try to identify the source of the stress and try to manage that. Um, there are some other medications called ACE inhibitors that can help the heart muscle kind of uh remodel and heal in in the right uh remodel in the right direction and heal, hopefully in a more stable, progressive uh fashion. We're still trying to find out what the best therapies are for this type of condition. We're also still trying to find out if there are some people we think there are, who are at risk for developing this condition repeatedly and potentially having longer-term effects that we still have yet to understand because we again we're we're not doing as good a job as we should at making the diagnosis. So we are still at the starting points of trying to uh follow people longer term to understand what are truly longer-term effects.

SPEAKER_00 14:09

Wow. And here again, you know, we all we all know while we're on this journey, things some things are out of our control, but we're able, we we can't take the reins. So there are things that we can do to help ourselves, and we know that self-care and rest rest restorative care can go a long way. So, what about meditation? Should we be looking at like breathing more throughout the day? Meditation, yoga.

SPEAKER_01 14:32

I'm a big believer meditation for everybody, for everything. If we if we can do that, you know, so funny. Some things in life, in health and medicine, um have some of the potentially greatest benefits to us. Uh and I'm talking in the whole body sense, not just for specific disease conditions or specific organ systems. Um, and so meditation is one of those, it's understudied, uh, but I believe it's it's it's truly beneficial for those who can um sort of figure out how to make it work. That's that's the trick. Um, the other is exercise. And you know, I I I I have a saying I I often use my patients, I say, you know, if you could take everything that exercise does for you and put it in a pill, each pill would be worth a million dollars. And every pharma company would be fighting tooth and nail for the formula.

SPEAKER_00 15:22

Exactly. Exactly.

SPEAKER_01 15:24

Yeah, and the irony is the irony is exercise is actually free. So that's that's the punchline. That's the punchline. But the the key is, you know, we we still struggle with trying to find the time, trying to figure out what is the right exercise prescription for each person. Everybody's different. So you know, everybody needs to figure out on an individual level what type of exercise works for me, for my lifestyle, for my schedule, for you know, my resources, for my space, my environment, all those things. And then for my medical and health needs, you know, am I somebody who has knee arthritis? And so I can't really do exercises that's gonna, you know, the of the type that's gonna bother my knees. Or am I somebody who, you know, has access to a pool or doesn't have access to a pool, or you know, is it safe to walk around my neighborhood? All those issues need to be taken into account. But exercise, all these things that are ironically, paradoxically free can be the kinds of things that can really help us keep our heart as well as our brains healthy.

SPEAKER_00 16:26

Thank you. I love that. Yeah, I try to walk every day and I'm like, it's free, it's fit, there's no cost to it. And if if you're lucky enough to live in a certain neighborhood where, you know, say a certain part of the country, you know, where the weather's great all year long, um, that's even better. But if not, you you have to find your groove, like you said, find your thing. Yeah, and uh just work it out. Dr. Ching, this has been such a great discussion. Um, thank you so much for coming on the podcast and sharing this crucial information with us.

SPEAKER_01 16:56

Yeah, thank you so much for having me. It's been fun.

SPEAKER_00 16:58

And now I have to do this. I know you're busy, busy with other projects. Can you drop some nuggets on what you're working on for the near future that impacts women of a certain age?

SPEAKER_01 17:08

Oh, I'm glad you asked. Um, we are in the business of studying and doing research on all different types of factors that um impact uh females versus males comparatively across the lifespan. So youth all the way to uh older age. We're particularly interested, of course, in what happens to us as we reach those advanced years as we age because things become more complicated. That's when things become not only more complicated, but also more different, it turns out, between males and females, men and women. So we have been working on um blood pressure in particular. How does blood pressure change over time? Uh, and as we age in males versus females, how does that play out differently? How does that set us up uh for different types of cardiovascular diseases and neurocognitive and brain conditions? Um, you know, we all always want to keep our brain at the end of the day, actually, you know, it being the most important organ. How does that differ as we age as females uh and males? And of course, tacotsubo syndrome is is really part of that um that line of inquiry because Takotsubo syndrome really is, you know, in the preeminent example of how the heart and the brain really are interconnected. And when thing when something goes wrong, uh that connection becomes really obvious. And so we are doing a whole lot of studies, um, sort of trying to understand how the heart and the brain are connected as we age, how blood pressures uh and blood pressure changes are part of the picture, and how we might even one day uh discover some um uh some of the molecular um uh determinants, the underpinnings that you know, so take us beyond genes. Uh what is it that we can um try to determine um uh about our our lifestyle, our diet? Uh what are the things that we can potentially change to help keep us healthy and on track?

SPEAKER_00 18:59

Yes, I'm gonna love that discussion because you know that's a great debate. Because if your parents had heart high blood pressure or heart issue, does that mean that you're gonna have it? And can you beat those odds? So that's I want to talk about that. I love that.

SPEAKER_01 19:11

No, that's so key and so important. I always tell people, you know, um, when you think about genes, genes are kind of like um think of life as a game of cards, and genes are the are the the hand that you're dealt with. So it doesn't dictate whether you win or lose the game. How you win, how whether you live win or lose the game is all about how you play the game with the cards you're dealt with. So your genes are the cards that you're dealt with, but you have choice, and uh you your your fate is not in your genes, it's not in the cards you're dealt with. You it's how you play the game. And so that's what we're here to do is try to figure out how can we help people figure out with the with the hand of cards they're dealt with, how can they make the best of that and ultimately come at winners?

SPEAKER_00 19:55

I love that. That's a future podcast with you as a guest, and we hope that you're gonna come back on the show. We'd love to. It'd be a pleasure. Thank you, Dr. Susan Ching. Again, she's the author of a study on broken heart syndrome, and she's also the director of public health research at Cedar Sinai Schmidt Heart Institute in Los Angeles. Dr. Susan Chang, you have been great. Thank you very much.

SPEAKER_01 20:19

Thank you so much for having me.

SPEAKER_00 20:20

So there you have it. Excellent information to protect the heart. Hashtag good stuff. And it's also very important information, of course. And that reminds me, I need to find a good meditation app. I'm open to suggestions. All right, listeners, if you have an idea for a podcast or if you want to be one of our guests, simply email us at info at agelessglamourgirls.com. Again, that's info at agelessglamourgirls.com. We would love to hear from you. You can also find us on Facebook and Instagram. All right, loves, thank you so much for tuning in to the Ageless Glamour Girls Podcast. I'm Marquita Curtis Haynes, founder and CEO of the lifestyle brand Ageless Glamour Girls. Here's the Healthy Aging and Joyful Living. Reconnect soon. Bye bye for now.