Stress caused by coronavirus pandemic could be behind spike in broken heart syndrome among Americans: Study
Known as stress cardiomyopathy, it occurs in response to physical or emotional distress and causes dysfunction or failure in the heart muscle
From social isolation to job loss and concerns about ourselves or loved ones getting Covid-19, it is no secret that we are living in stressful times and that stress could be leading to more broken hearts. Researchers have found that there has been a significant increase in “broken heart syndrome” among some patients in the US who do not have Covid-19, suggesting the mental and physical toll of the pandemic on people.
According to Ohio-based Cleveland Clinic researchers, cases of broken heart syndrome doubled in two of their hospitals in March and April of 2020 — just as the coronavirus pandemic started in the US. Also known as stress cardiomyopathy, it 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 an enlargement. Other symptoms include irregular heartbeat, fainting, low blood pressure, and cardiogenic shock, which is 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 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," says the research team in their analysis published in JAMA Network Open.
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 30 and compared them with four control groups of ACS patients before the pandemic. They found a significant increase in patients diagnosed with stress cardiomyopathy, reaching 7.8% during the coronavirus pandemic compared with pre-pandemic incidences that ranged from 1.5% to 1.8%.
"There was a significant increase in the incidence of stress cardiomyopathy during the Covid-19 period, with a total of 20 patients with stress cardiomyopathy (incidence proportion, 7.8%), compared with pre-pandemic timelines, which ranged from 5 to 12 patients with stress cardiomyopathy (incidence proportion range, 1.5%-1.8%). The rate ratio comparing the Covid-19 pandemic period to the combined pre-pandemic period was 4.58," the findings state.
The researchers conclude that increase was likely connected to the associated psychological, social and economic stress due to the imposed quarantine, lack of social interaction, strict physical distancing rules and its economic consequences in people’s lives. All the patients diagnosed with stress cardiomyopathy tested negative for the new coronavirus.
"No patients with stress cardiomyopathy were found to have Covid-19, suggesting an indirect, psychological, social and economic pandemic-related stress mechanism behind the disease process," write authors. They have called for more studies in this area, particularly to see if this trend is present in other regions of the country. According to the analysis, 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 death between the groups.
"Each time we have a stress response, it’s the fight or flight response, and the adrenaline goes up, and how one reacts to that emotionally is different, but how our organs react to it is different as well," says Dr Ankur Kalra, a Cleveland Clinic cardiologist in the Sections of Invasive and Interventional Cardiology and Regional Cardiovascular Medicine, in the report.
"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. The stress can have physical effects on our bodies and our hearts, as evidenced by the increasing diagnoses of stress cardiomyopathy we are experiencing," says Dr Kalra, who led the study.
Patients with stress cardiomyopathy generally recover their heart function and recover in a matter of days or weeks, but 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, says the team.
"While the pandemic continues to evolve, self-care during this difficult time is critical to our heart health, and our overall health. 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," says senior author of the study, Dr Grant Reed, director of Cleveland Clinic's STEMI (ST-elevation myocardial infarction) program.