Watch out for this kind of ‘invisible’ heart attack

At the end of “The Notebook,” a movie based on the Nicholas Sparks novel, Noah Calhoun visits his wife Allie in the hospital. Noah and Allie have been married for decades, and Allie has been in a nursing home suffering with Alzheimer’s disease.

Noah lies down next to Allie in her hospital bed. The two hold hands, and are found in the morning still holding hands, both dead.

Fiction, of course. But based in reality nonetheless.

Can you really die of a broken heart? And is it just the death of a loved one that can damage your heart in this way?

In short, the answers are: yes, and no.

As dramatic as all this sounds, medicine and research have documented a syndrome that is often mistaken for a more traditional heart attack. It damages the heart in other ways, though, making it hard to predict, and though less frequently fatal, it still can be a killer…

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Takotsubo syndrome: the invisible heart attack

Also known as stress cardiomyopathy or “broken heart syndrome,” Japanese doctors were the first to observe and describe this syndrome, where the heart tends to take on a unique shape, resembling a “takotsubo,” or traditional Japanese pot for trapping octopus.

Takotsubo syndrome is caused by a sudden or unexpected emotional stress, such as the death of a loved one. But other stressors are associated with this type of heart disease as well, such as:

• Severe pain
• Domestic violence
• A car or other accident
• Unexpected loss, illness or injury of a close friend or a pet
• Intense fear
• Financial loss or difficulties

The symptoms of a “stress heart attack” can be similar to those you’re familiar with: chest pain and tightness, shortness of breath, dizziness and low blood pressure and an irregular heartbeat.

Most of the time, though, these remain “invisible” attacks. Blood tests will show no signs of heart damage. There will be no signs of arterial blockage, and an EKG will look nothing like it does in a traditional heart attack.

But the physical effects of this syndrome are every bit as real as what happens during a heart attack…

The lower part of the left ventricle bulges and enlarges, resembling the shape of the takotsubo pot. This section of the heart cannot pump blood effectively, and so the other three chambers take on more stress to pick up the slack.

It can only do this so long until it just gives out.

Research tries to pinpoint the cause

Recent research is looking at just what happens to the heart when it “breaks,” and what can be done about it.

In 2015, an international team of doctors from the United States and Europe studied 1750 patients with Takotsubo cardiomyopathy. Ninety percent of them were women in their 60s, a trend that other research confirms.

The most common trigger, though, was not emotional shock, but physical illness such as lung problems or infections. And, contrary to popular belief, the rate of death was about the same as that of people suffering more traditional heart attacks.

Atrial fibrillation (AFib), or irregular heartbeat, is often present with Takotsubo syndrome. AFib decreases heart rate and makes it harder to get blood traveling through the heart. This can lead to blood clots, stroke or heart failure.

Researchers at the University of Minnesota followed two groups of people for over three years: more than 15,000 people ages 45 to 64, and another 5000 people ages 65 and older.

In the younger group, people with AFib had more than three times the risk of sudden cardiac death as compared to healthy peers, while the older group had more than double the risk.

The precise cause of stress cardiomyopathy isn’t fully understood. But experts think it has something to do with the surge or stress hormones, particularly adrenaline, that “stun” the heart and trigger changes in heart muscle cells or coronary blood vessels (or perhaps both).

Studies seem to suggest that higher levels of estrogen may play a protective role against the left ventricle damage that occurs in Takotsubo syndrome. If so, it could explain why older women seem to be more susceptible to this “silent” heart attack.

How to prevent Takotsubo syndrome

Yoga and meditation. By learning to manage your stress response, you can gain more control over the stress hormones that are part of this syndrome. Deep breathing, meditation and a regular yoga practice are a way to gain this control.

Aerobic exercise. The more you can strengthen your heart muscle, the better chance it has of standing up to stressors and the stress hormones that trigger heart attacks.

Eat heart healthy foods. A Mediterranean diet or similar eating plan that emphasizes whole foods, fruits and vegetables and healthy fats is the best way to protect your heart against any onslaught of stress.