Impaired Risk Review...
Broken Heart Syndrome
Robert Goldstone
May 2018

Is it true, as stories suggest, you can die of a broken heart?  Likewise, can you have suffered a broken heart and get a standard life insurance policy?  The answer to both questions is yes.  The entity is known as Takotsubo cardiomyopathy, or as stress cardiomyopathy, and is very real.  

Takotsubo is actually a Japanese word that translates to “octopus trap.” It was used to characterize the syndrome after the heart took on the shape of a Japanese fishing pot during an acute episode.  Broken heart syndrome is triggered by stressful situations, both physical and emotional ones.  Surgery and serious illness are some on the physical scale; death of a loved one, emotional memories, or constant anxiety—even the breakup of a relationship—can be a cause.  You can even suffer it during a usually joyful event—like the shock of a surprise party!  

The syndrome generally begins with acute chest pain.  An EKG in about half the cases shows the typical signs of having an acute heart attack.  All the signs of an acute event occur: Chest pain, shortness of breath, nausea and the patient in an emergency situation is treated with heart attack protocol.  Cardiac enzymes, which acutely rise during an event, are mainly normal to somewhat elevated but not in  proportion to the symptoms.  An angiogram and cardiac catheterization used to find the site of narrowing or affliction of the coronary arteries though comes back negative and indicates an absence of significant cardiac disease.

So how is the diagnosis made?  Stress cardiomyopathy has very distinctive wall motion abnormalities in the heart, particularly in the large left ventricle which is the chamber charged with getting blood out of the heart to the rest of the body. The base of the left ventricle appears normal while the remainder of the chamber has very disordered or even absent movement.  There is ballooning of the mid left ventricle, and that classical “octopus trap” look that accounts for the Takotsubo name.  The main criteria then are a stressful event to cause the symptoms, EKG changes different from the normal tracing, an absence of any cardiac blockage on perfusion or catheterization testing, and a return to normal in a relatively short time.

The etiology of stress cardiomyopathy is still debated and there is no uniform agreement on what the actual mechanism is.  A tightening of the vessels (spasm) that is temporary has been proposed.  A rush of catecholamines for the severe emotional or physical stress is another hypothesis. Dysfunction on a microvascular basis that the angiogram doesn’t identify is yet another thought.  In any case the symptoms and results from the event are quite real.       

How does someone die of Takotsubo if the findings are temporary and seemingly without any significant coronary blockage?  During the event, heart failure is a real concern with the important left ventricle not functioning properly.  Low blood pressure and shock are very real risks.  Cardiac arrhythmias can cause a stoppage of the heart that may not be treatable.  In cardiogenic shock, coronary care and even mechanical support of the heart is a mainstay of treatment.

What happens after the event has been successfully treated and the storm weathered?  Most people go on to live completely normal lives with no cardiac compromise at all.  The heart returns to its normal function without any signs of permanent damage.  The average age for stress cardiomyopathy is 60-75; a high majority of the affected individuals are women.  A broken heart can occur more than once, but the majority of Takotsubo events are singular.

In those that are affected, a reasonable time period must go by without any cardiac complications for favorable consideration. At that time, if heart function is normal and the stressor (whatever it may have been) has been removed, the heart is considered normal in function and a standard issue may be considered as if the event was fully and successfully treated. A broken heart truly can be mended… 

Author's Bio
Robert Goldstone, MD, FACE, FLMI
MD, FACE, FLMI, board certified internist and endocrinologist, was most recently vice president and chief medical officer for Pacific Life and Pacific Life and An­nu­ity. He has extensive brokerage and life insurance experience, having been medical director at both MetLife Brokerage and Transamerica Occidental Life. Goldstone is board certified in insurance medicine and the inaugural recipient of the W. John Elder Award for Insurance Medicine Journalism Excellence. He was also honored as a fellow of the prestigious American College of Endo­­­crinology and has written monthly for Broker World since 1991. Goldstone does consulting full or part-time as well as on a fill-in basis for companies who need a medical director/physician. He can be reached by ­telephone at 949-943-2310. Emaill: [email protected]

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