On July 3, Wanda Kump was overwhelmed by stress and grief. It was the day of her mother’s funeral. Not only had she watched her mother take her last breath while in hospice a few days prior, but her sister-in-law died the very next day.
“The day of the funeral is when I didn’t feel well; light headed and sick to the stomach,” said the 51-year-old Mankato mother. “That’s when I fell, and broke my hip.”
Later at the emergency room at Mayo Clinic Health System in Mankato, as medical staff determined the extent of Kump’s hip fracture, they made another discovery soon after – her heart was misshapen. After running a series of tests over the next couple of days, they eliminated all other possibilities. It wasn’t a heart attack, arrhythmia or blocked arteries from high cholesterol. Kump was literally suffering from a broken heart.
On the day Kump arrived, medical staff had already noticed something was amiss when they checked her heart’s electrical activity, a routine procedure prior to a surgery. That was followed by an echocardiogram, which measures sound waves to create images of the heart.
“We noticed there was a different appearance to the left ventricle, it was kind of bulged out,” said Susan Haugh, a nurse practitioner at Mayo who specializes in cardiology.
That signature bulging is characteristic of takotsubo cardiomyopathy, better known as broken heart syndrome. Haugh is part of a team of more than a dozen physicians and advanced practice providers in her practice who see about 20 cases of broken heart syndrome a year, although Haugh suspects there are people who are undiagnosed.
Women in their 50s and 60s are especially vulnerable. According to Harvard Medical School, more than 90 percent of the reported cases of broken heart syndrome involve women between the ages of 58 and 75.
The reasons behind the cause of broken heart syndrome are varied, but generally involve a life-changing tragedy or the build-up of several stressors.
“It can be any number of things,” Haugh said. “We’ve had it related to dying, pets dying, people having a divorce, people having some type of a run-in with the law or a close family member has a run-in with the law, and it just stresses them so much.”
Recent studies have also found evidence of people suffering from broken-heart syndrome in response to the stressors of a cancer diagnosis and treatment. Researchers in Houston found 30 patients undergoing treatment for cancer also had broken-heart syndrome over a 6-year time period.
Haugh said the patients they see will come to the hospital with shortness of breath or difficulty breathing. If they discover a misshapen ventricle that bulges out of only one section of the heart, they’re able to eliminate other possibilities.
When a patient has heart problems, some of the first questions medical providers ask relate to what’s going on in that person’s life. When Kump told her what she had been dealing with, it all came together, like pieces of a puzzle.
“We are so much better at diagnosing it now,” Haugh said. “For one, echocardiograms have gotten better, and we do them a lot more quickly than we used to do. It was a special test and now it’s an everyday type of a test. I think it’s a lot more prevalent than we ever thought it was before.”
It can be confused with a heart attack because the symptoms — lightheadedness, shortness of breath and chest pain — are similar.
“Their heart enzymes usually are elevated, they usually have chest pain or are very short of breath, very similar to what you might have if you were actually having a heart attack,” Haugh said. “But in a heart attack you don’t see that funny, misshapen ventricle.”
Health care professionals usually prescribe a combination of beta-blockers, which slow down and strengthen the heart muscles, and ace-inhibitors, which widen the blood vessels. Luckily, most people suffering from the affliction usually recover after a few weeks.
“They explained takotsubo syndrome to me,” Kump said. “And then I started getting better.”
Haugh said one of those medications make the heart work less hard, lowering the number of heart beats per minute, so the heart is able to rest. The other helps strengthen each contraction, leading to fewer contractions while strengthening the heart’s ability to contract. Those two factors give the heart the time it needs to heal. After about six weeks, Kump no longer had to take those medications.
“She’s not on it anymore because her blood pressure was low; we repeated the echocardiogram in mid-August,” Haugh said. “By then, her pumping function of her heart was back to normal.”
Kump has since discovered that meditation has helped her manage stress, and she found a support group for women who had recently lost their mothers. But looking back, she realized all of the signs were there.
“I had a lot of grief,” Kump said. “I cried a lot and it was hard. My mom was the glue that kept the family together. It’s made me aware; I didn’t realize that stress could do that to you.”
When Haugh first entered the field, the concept of broken heart syndrome was still relatively new. She saw her first patient diagnosed with broken heart syndrome 15 years ago. Last year she diagnosed seven patients. Now it’s widely accepted across the medical community as a very real issue that probably affects people who are not even aware they have it until they go to the hospital.
“It makes us very compassionate, to realize the stress was so significant it actually made the heart muscle change or morph,” Haugh said. “That’s a sad situation. We should always listen to the patient because there’s always a story behind it.”