Cleveland Clinic Researchers Find Rise In Broken Heart Syndrome During COVID-19 Pandemic

Broken heart syndrome, or stress cardiomyopathy, occurs in response to stressful events

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

Stress cardiomyopathy occurs in response to physical or emotional distress 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. The left ventricle of the heart, however, 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 impact of stress hormones on the cells of the heart).

“The COVID-19 pandemic has brought about multiple levels of stress in people’s lives across the country and world. People are not only worried about themselves or their families becoming ill, they are dealing with economic and emotional issues, societal problems and potential loneliness and isolation,” said Ankur Kalra, M.D., a Cleveland Clinic cardiologist in the Sections of Invasive and Interventional Cardiology and Regional Cardiovascular Medicine, who led the study. “The stress can have physical effects on our bodies and our hearts, as evidenced by the increasing diagnoses of stress cardiomyopathy we are experiencing.”

The causes of stress cardiomyopathy, also known as Takotsubo cardiomyopathy, are not fully understood. However, physicians believe that a person’s reaction 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 instead of in a steady, normal pattern.

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

The study was published today in JAMA Network Open.

“While the pandemic continues to evolve, self-care during this difficult time is critical to our heart health, and our overall health,” said Grant Reed, M.D., M.Sc., director of Cleveland Clinic’s STEMI (ST-elevation myocardial infarction) program and senior author for the study. “For those who feel overwhelmed by stress, it’s important to reach out to your healthcare provider. Exercise, meditation and connecting with family and friends, while maintaining physical distance and safety measures, can also help relieve anxiety.”

Patients with stress cardiomyopathy generally recover their heart function and recover in a matter of days or weeks, although the condition can occasionally cause major 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 warranted in this area, particularly to see if this trend is present in other regions of the country.

About Cleveland Clinic
Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Among Cleveland Clinic’s 67,554 employees worldwide are more than 4,520 salaried physicians and researchers, and 17,000 registered nurses and advanced practice providers, representing 140 medical specialties and subspecialties. Cleveland Clinic is a 6,026-bed health system that includes a 165-acre main campus near downtown Cleveland, 18 hospitals, more than 220 outpatient facilities, and locations in southeast Florida; Las Vegas, Nevada; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2019, there were 9.8 million total outpatient visits, 309,000 hospital admissions and observations, and 255,000 surgical cases throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 185 countries. Visit us at clevelandclinic.org. Follow us at twitter.com/CCforMedia and twitter.com/ClevelandClinic. News and resources available at newsroom.clevelandclinic.org.

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