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Takotsubo cardiomyopathy

  1. Other Names: Broken-heart syndrome, Transient apical ballooning syndrome, Apical ballooning cardiomyopathy,Stress-induced cardiomyopathy, Gebrochenes-Herz-Syndrom, and Stress cardiomyopathy.
    Definition:
    Takotsubo cardiomyopathy is a type of non-ischaemic cardiomyopathy in which there is a sudden temporary weakening of the myocardium. Because this weakening can be triggered by emotional stress, It occurs as the response of the heart to sudden, intense emotional stress such as the death of a spouse; rejection at the workplace; acute fear; or uncontrolled anger. These intense emotions can cause immediate breathlessness or strokes. The broken heart can occur simultaneously or a few minutes later. Stress cardiomyopathy is a well-recognized cause of acute heart failure, lethal ventricular arrhythmias, and ventricular rupture.

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Around ten years ago, there were a few high profile deaths in young people. They were diagnosed as having died from a “broken heart”. Now, a broken heart or stunned myocardium syndrome is a documented condition.
Symptoms:
Takotsubo cardiomyopathy or Broken heart syndrome symptoms can mimic a heart attack.The symptoms are similar to a heart attack – chest pain, sweating, giddiness or dizziness, nausea, vomiting, weakness and palpitations. Blood pressure may drop. Heart failure may develop.

Any long-lasting or persistent chest pain could be a sign of a heart attack, so it’s important to take it seriously and call your doctor if you experience chest pain.

Causes:
The exact cause of Takotsubo cardiomyopathy is not very clear. It is thought that a surge of stress hormones, such as adrenaline, might temporarily damage the hearts of some people. How these hormones might hurt the heart or whether something else is responsible isn’t completely clear. A temporary constriction of the large or small arteries of the heart may play a role.

Takotsubo cardiomyopathy is often preceded by an intense physical or emotional event. Some potential triggers are:

*News of an unexpected death of a loved one
*A frightening medical diagnosis
*Domestic abuse
*Losing a lot of money
*Natural disasters
*A surprise party
*Having to perform publicly
*Job loss
*Divorce
*Physical stressors, such as an asthma attack, a car accident or major surgery

It’s also possible that some drugs, rarely, may cause broken heart syndrome by causing a surge of stress hormones. Drugs that may contribute to broken heart syndrome include:

*Epinephrine (EpiPen, EpiPen Jr), which is used to treat severe allergic reactions or a severe asthma attack
*Duloxetine (Cymbalta), a medication given to treat nerve problems in people with diabetes, or as a treatment for depression
*Venlafaxine (Effexor XR), which is a treatment for depression
*Levothyroxine (Synthroid, Levoxyl), a drug given to people whose thyroid glands don’t work properly
Differances between Takotsubo cardiomyopathy and hear attack are:

Heart attacks are generally caused by a complete or near complete blockage of a heart artery. This blockage is due to a blood clot forming at the site of narrowing from fatty buildup (atherosclerosis) in the wall of the artery. In Takotsubo cardiomyopathy, the heart arteries are not blocked, although blood flow in the arteries of the heart may be reduced.
Diagnosis:
Takotsubo cardiomyopathy or Transient apical ballooning syndrome is found in 1.7–2.2% of patients presenting with acute coronary syndrome. While the original case studies reported on individuals in Japan, Takotsubo cardiomyopathy has been noted more recently in the United States and Western Europe. It is likely that the syndrome went previously undiagnosed before it was described in detail in the Japanese literature.

The diagnosis of Takotsubo cardiomyopathy may be difficult upon presentation. The ECG findings are often confused with those found during an acute anterior wall myocardial infarction. It classically mimics ST-segment elevation myocardial infarction, and is characterised by acute onset of transient ventricular apical wall motion abnormalities (ballooning) accompanied by chest pain, dyspnea, ST-segment elevation, T-wave inversion or QT-interval prolongation on ECG. Elevation of myocardial enzymes is moderate at worst and there is absence of significant coronary artery disease.

The diagnosis is made by the pathognomonic wall motion abnormalities, in which the base of the left ventricle is contracting normally or is hyperkinetic while the remainder of the left ventricle is akinetic or dyskinetic. This is accompanied by the lack of significant coronary artery disease that would explain the wall motion abnormalities. Although apical ballooning has been classically described as the angiographic manifestation of takotsubo, it has been shown that left ventricular dysfunction in this syndrome includes not only the classic apical ballooning, but also different angiographic morphologies such as mid-ventricular ballooning and rarely local ballooning of other segments.

The ballooning patterns were classified by Shimizu et al. as takotsubo type for apical akinesia and basal hyperkinesia, reverse takotsubo for basal akinesia and apical hyperkinesia, mid-ventricular type for mid-ventricular ballooning accompanied by basal and apical hyperkinesia and localised type for any other segmental left ventricular ballooning with clinical characteristics of takotsubo-like left ventricular dysfunction.

The ECG changes are atypical, with imprecise changes in the ST segment and T waves. They are “suspicious of but non conclusive” of myocardial infraction. Blood tests for the enzyme creatine kinase and proteins troponin should be done. These are elevated in a heart attack. In a stunned heart, these results too are inconclusive. The echocardiogram is the clincher. The heart is ballooned out. This change occurs typically at the apex of the heart. It is important to make a distinction between heart attack and takotsubo as the medication is different.

Treatment:
The treatment for takotsubo is mainly supportive. Medication is given to remove fluid from the lungs and prevent clots. Recovery occurs within a few days.

About two per cent of people who were thought to have a heart attack actually had broken hearts. In the case of women, this increases to seven per cent. Women, mainly menopausal ones (60-75 years), have “broken hearts” eight to nine times more often than men. Some people are genetically prone to “broken hearts.” Depression plays a role in susceptibility to this condition. Recurrences can occur in 10 per cent of people.

People who are in poor physical condition do not need severe emotional stress to suffer a broken heart. An episode may be precipitated by a minor event like rejection, or even a lecture or talk before an audience.

In order to never develop this condition; it is important to develop metal and physical toughness. Walking for 40-60 minutes a day at a brisk pace exposes the heart to small doses of adrenaline and nor adrenaline in a controlled manner. The heart gets conditioned and is immune to sudden chemical surges. Meditation and yoga provide calmness and the mental strength to cope with good days and bad.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Takotsubo_cardiomyopathy
http://www.mayoclinic.org/diseases-conditions/broken-heart-syndrome/basics/causes/con-20034635
http://www.telegraphindia.com/1141208/jsp/knowhow/story_2612.jsp

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Lower Your BP, Live Longer

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In western countries, the number of people affected by high blood pressure (BP) or hypertension is decreasing. In India, however, the figure is creeping up, albeit marginally (2-3 per cent). This is worrying because, untreated, hypertension may result in complications like a heart attack, heart or kidney failure, tearing of the blood vessels and loss of vision. It can also cause subtle loss of memory and the ability to think clearly.
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BP indicates the force with which the heart pumps blood against the blood vessel. It has two values — an upper or systolic and a lower or diastolic. Values of 120/80 are normal, while 139/89 indicates pre-hypertension and 140/90 or above hypertension. With age, the blood vessels tend to harden, decreasing their pliability. This causes a peculiar type of hypertension where only the upper value is high. About 70 per cent of the population over the age of 60 has this type of systolic hypertension. BP should be measured every two years after the age of 20 and yearly after 40.

Normal BP:->..
The risk of hypertension increases with age, obesity, a family history of high BP, kidney diseases, diabetes, endocrine diseases, smoking, alcohol consumption, medications like corticosteroids, birth control pills or those for losing weight. Narrow abnormally placed blood vessels present from birth can also lead to high BP. If no cause can be detected, it’s called “essential hypertension” and requires medication to prevent complications. Even isolated systolic hypertension requires treatment.

BP is linked to salt intake. A high salt intake results in elevated BP. The effect is even more pronounced in people (around 20 per cent of the population) who are “salt sensitive”.

The recommended salt intake for a normal person is 5gm or 1 teaspoon a day. But the “hidden salt” must also be considered. All food and even drinking water contains varying amounts of natural salt. Sodium (a component of salt) is added to food products in the form of monosodium glutamate, sodium nitrite, sodium saccharin, baking soda (sodium bicarbonate) or sodium benzoate. These are ingredients in condiments and seasonings like tomato sauce, soy sauce and pickles. Processed meats such as bacon, sausage and ham, and fast foods like burgers and pizzas are high in sodium content.

Medications belonging to groups such as diuretics, alpha blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers and rennin inhibitors are available to control blood pressure. The pharmaceutical industry also introduces “new and improved” drugs in the market with monotonous regularity. Control remains unsatisfactory in many patients who are then dosed with two or more anti hypertensives. The older, long-acting diuretics, surprisingly, remain one of the most effective medications, either as an adjuvant to existing medicine or alone.

Better control of BP with lower doses of medication can often be achieved if the person is willing to make certain lifestyle changes. Weight needs to be ideal. As weight increases, so does the pressure on your artery walls. To calculate your ideal body weight, multiply your height in meter squared by 23.

Inactive people have a faster heart rate, forcing the heart to work harder for longer periods of time. Aerobic exercise like walking, jogging, swimming or running needs to be done daily. It should be started at the age of around six with 20 minutes of running. Gradually this should be increased to an hour by the age of 18 years.

Smoking (even second-hand smoke), using snuff or chewing tobacco releases chemicals into the body which damage the blood vessels, making them narrow and thus increasing the BP.

Salt makes the body retain fluid, which in turn increases the BP. Limit your intake to 5gm a day. Sodium can be balanced by potassium found in fresh fruits and vegetables. Eat four to six helpings of this a day.

Vitamin D obtained through the diet and by exposure to sunlight affects the levels of a BP-regulating enzyme in the kidneys. Inadequate levels can indirectly elevate the BP.

Heavy drinking can cause permanent heart damage. Even two or three drinks in a single sitting can cause the release of chemicals that temporarily elevate the BP.

Stress can elevate the BP. It needs to tackled with meditation and yoga. Chronic diseases like diabetes, high cholesterol, kidney disease and sleep apnoea need to be controlled as they contribute to the risk of high BP.

Children too are at risk from as early as six or eight years if they are obese, inactive and eat high sodium snacks. These lifestyle changes, therefore, need to be initiated from a young age.

You may click to see :10 Ways to Lower Your Blood Pressure Without Medication

Source: The Telegraph (Kolkata, India)

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Chocolate Protects Against Heart Disease

Numerous studies have shown that cocoa has a protective effect against cardiovascular diseases. The reason for this has now been uncovered by researchers at Linköping University in Sweden. When a group of volunteers devoured a good-sized piece of dark chocolate, it inhibited an enzyme in their bodies that is known to raise blood pressure.

“We have previously shown that green tea inhibits the enzyme ACE, which is involved in the body’s fluid balance and blood pressure regulation. Now we wanted to study the effect of cocoa, since the active substances catechins and procyanidines are related,” says study leader Ingrid Persson.

The researchers recruited 16 healthy volunteer subjects for the study. They were not tobacco users and were not allowed to take any pharmaceuticals for two weeks. During the last two days they were not allowed to eat chocolate or anything containing similar compounds, including many kinds of berries and fruits, nor could they drink coffee, tea, or wine.

When the study took place, everyone in the group – ten men and six women between the ages of 20 and 45 – ate 75 grams of unsweetened chocolate with a cocoa content of 72 percent. To analyze what happened with the ACE enzyme, blood samples were taken in advance and then a half hour, one hour, and three hours afterward.

In the sample taken three hours afterward, there was a significant inhibition of ACE activity. The average was 18 percent lower activity than before the dose of cocoa, fully comparable to the effect of drugs that inhibit ACE and are used as a first-choice treatment for high blood pressure.

When the activities of the enzyme decline, the blood pressure goes down with time. As expected, no such effect was found in the subjects. To show this, the study would have to continue over a longer period.

“Our findings indicate that changes in lifestyle with the help of foods that contain large concentrations of catechins and procyaninides prevent cardiovascular diseases,” she says

Source :Elements4Health

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What Causes Arteries Clog Up

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British scientists have identified an enzyme that plays a crucial role in clogging up of arteries . Here’s what causes arteries to clog up :

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They have discovered that an enzyme called matrix metalloproteinase-8 that raises blood pressure and causes abnormal build-up of cells in the arteries – both of which increase the risk of heart disease….

“Our research tells us that this enzyme plays a crucial role in the build-up of fatty deposits in the arteries which causes heart disease,” said lead researcher Shu Ye, Professor of Molecular Medicine and Genetics at Queen Mary, University of London.

“Many patients with high blood pressure or heart failure are currently treated with ACE inhibitor drugs. However, some patients do not respond sufficiently to ACE inhibitors alone.

“We hope that what we’ve found here could be the basis for new drugs that can enhance the effects of ACE inhibitors, which would reduce deaths from heart disease,” Ye added.

During the study, researchers genetically engineered mice to lack the MMP8 enzyme.

The mice were fed on a Western-style diet high in fat and cholesterol and compared to normal mice fed on the same diet. The mice, which lacked the enzyme, had clearer arteries and lower blood pressure.

The researchers also studied 2,000 patients who were being tested for clogs in arteries leading to their hearts with a test called a coronary angiogram.

They found that around 25 per cent of these patients had a slightly different version of the gene for MMP8 and their arteries were more clogged than other patients.

Source: The Times Of India

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Whey Protein Improves Heart Health

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A whey–protein-rich ingredient may improve blood vessel function in healthy individuals, reports a new randomized, double-blind study.
Two weeks of supplementation resulted in a 1.5 percent improvement in blood flow. According to the researchers, the whey protein-derived ingredient may work via an angiotensin converting enzyme (ACE)-inhibitory activity.

ACE inhibitors work by inhibiting the conversion of angiotensin I to the potent vasoconstrictor, angiotensin II, thereby improving blood flow and blood pressure.

Resources:
NutraIngredients August 5, 2009
Nutrition Journal July 22, 2009; 8:34

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