It's the classic Bollywood script. Man hears his daughter has eloped, he clutches his heart and collapses. He is rushed to an emergency room where a grim-faced doctor shakes his head and pronounces, "He is no more".
Now, the modern twist. The father-of-the-runaway daughter clutches his heart and is rushed to the hospital. But he is told "all is well" and returns home, happy at the thought that he doesn't have to spend on the wedding.
This is possible. A heart attack-that-is-not is a medical mystery called Takotsubo Cardiomyopathy, or the broken heart syndrome.
The symptoms are not psychosomatic. Now, it seems the syndrome is not as rare as it was believed to be either. It causes 1-2 per cent of admissions for suspected heart attacks in industrialised countries, reported the British Medical Journal last week.
The condition, which affects mostly post-menopausal women, is associated with strong emotional or physical stress in 80 per cent of the cases.
The symptoms begin minutes to hours after exposure to a severe and unexpected stress or even physical stressors such as stroke, seizure, or an asthma attack.
In 80 per cent of the cases, symptoms disappear on their own within a couple of weeks. In others, heart damage persists, reported the European Heart Journal on Friday. Italian scientists found that the symptoms are caused by a spasm in the small blood vessels, which cannot be picked up by routine tests.
As usual, there is no data for India, where the syndrome is likely to be dismissed as a psychosomatic disorder. More so, because it affects more women than men. The largest registry of patients with Takotsubo Cardiomyopathy in the world — at Rhode Island Hospital in the US — shows that only one of the 40 patients diagnosed with the syndrome are men.
The clinical manifestations are also confusing. People with all the classic heart attack symptoms — acute chest pain, shortness of breath, congestive heart failure, low blood pressure, abnormal electrocardiogram (ECG) and blood tests readings that show high levels of heart disease-related enzymes — keep showing up. But the angiography is clear. Blood flow and heart function are also normal.
In a typical heart attack, blocked arteries show up and the heart cells starved of blood, die. The body responds by producing hormones and proteins which cause the small arteries to spasm and temporarily decrease blood flow to the heart.
The effect is temporary and reversible.
In rare cases, there could be severe heart muscle weakness and other potentially life-threatening effects. Death is rarer still. If symptoms persist, advanced life-support is needed. A broken heart that mends on its own is any day preferable.
It's cheaper too, but remember that no shock is worth permanent heart damage.