Broken heart syndrome has increased during the pandemic, small study suggests

Stress-induced cardiomyopathy or Takotsubo syndrome — which is often called “broken heart syndrome” — occurs when the heart muscles weaken, leading to chest pain and shortness of breath. It presents like a heart attack, but is triggered by stressful events, not blockages in the bloodstream. It can be deadly in rare cases, but patients usually recover within days or weeks.

Researchers at the Cleveland Clinic studied patients at two hospitals with heart trouble who were treated this spring, and compared them to patients with similar issues over the past two years. Patients during the pandemic were two times likelier to have broken heart syndrome, according to the study, which was published in the medical journal JAMA Network Open.

The study looked at 1,914 patients from five distinct two-month periods, including a sample of more than 250 patients hospitalized in March and April, during the early peak of the pandemic. The study concluded that the increase was likely connected to the “psychological, social, and economic stress” caused by the pandemic, which includes “imposed quarantine, lack of social interaction, strict physical distancing rules, and its economic consequences in people’s lives.”

“The pandemic has created a parallel environment which is not healthy,” said Dr. Ankur Kalra, the cardiologist who led the study. “Emotional distancing is not healthy. The economic impact is not healthy. We’ve seen that as an increase in non-coronavirus deaths, and our study says that stress cardiomyopathy has gone up because of the stress that the pandemic has created.”

The new research did not examine whether there was any connection between broken heart syndrome and the stress of having coronavirus, or watching a relative suffer from the disease. The patients in the study were tested for Covid-19 and none of their tests came back positive.

Public health authorities in the US and overseas have raised the alarm about the impact of the coronavirus on mental health, paying special attention to the isolation of socially distant living.

The director general of the World Health Organization, Tedros Adhanom Ghebreyesus, said in May, “the impact of the pandemic on people’s mental health is already extremely concerning.”

“Our work provides credence to the other health hazards that the pandemic has created,” Kalra said.

The new study didn’t find any meaningful change in the death rate between pre-pandemic patients and those who were hospitalized in March and April of this year, researchers said.

Limits to the research

There were limits to the small study. Researchers only reviewed medical records from patients in northeastern Ohio, and they said more work is needed to determine if these findings are true in other parts of the country, Researchers also said it would be worthwhile to explore the direct relationship between Covid-19 and broken heart syndrome, which wasn’t part of this study.

One expert on broken heart syndrome, formally known as Takotsubo syndrome, raised questions about the new study’s methodology and pointed out opportunities for potential bias.

“They might be completely right. I don’t object to the hypothesis. I object to the statistical methods,” said Dr. John Horowitz, an emeritus cardiology professor at the University of Adelaide in Australia, who has published more than 20 peer-reviewed papers on Takotsubo.

Researchers only studied patients who received a cardiac catheterization, a minimally invasive procedure commonly done to search for blockages in the heart’s arteries. Looking at only this slice of patients could lead to biases in the sample, Horowitz said, because it might exclude older and sicker patients from the study, as they are less likely to undergo a catheterization.

“It’s well-known that patients quite frequently get Takotsubo syndrome at times of extreme stress or during natural disasters,” Horowitz said. “But there are problems with the way the study was designed. I don’t believe all of these cases are Takotsubo. It’s as simple as that.”

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