INFORMATIVE SPEECH

Name: Najwa Syakirah Binti Mohd Shamsuddin Topic: Broken Heart Syndrome
Matric number: 2022901093 Group: TBA242/4D

Introduction
Introduce topic Assalamualaikum and a very good evening to my fellow classmates
and my respected lecturer, Puan Mia Emily. I am Najwa Syakirah
and today I will be presenting my speech about a disease called
Broken Heart Syndrome.
Credibility Have you guys ever heard about broken heart syndrome? I guess
some of you might get confused how broken heart can lead to a
disease. Do not worry I have come here well-prepared by doing a lot
of research.

To begin with, mind is a very powerful organ and broken heart is a

very powerful emotion. When these two combines, it can certainly
produce a physical reaction which can turn to an illness such as
broken heart syndrome or in a medical term it is known as
Takotsubo Cardiomyopathy.
Background of topic Broken heart syndrome is a temporary heart condition with
symptoms like those of a heart attack. Because both conditions
cause shortness of breath and chest pain, you may think you are
having a heart attack. However, there is no permanent heart
damage or blocked coronary arteries in broken heart syndrome.

Unlike a heart attack, broken heart syndrome occurs when a sudden

physical or emotional stressor causes your heart muscle to weaken
rapidly. A weak heart muscle could affect your heart's blood supply
and pumping function. If your heart isn’t pumping effectively, that
negatively affects your whole body as every cell in your body
depends on the steady supply of oxygen carried by your blood.
Central Idea The purpose of presenting this topic as my speech is to enlighten
the audience about what is the causes of broken heart syndrome
and who is typically diagnosed with broken heart syndrome. It was
fascinating to learn about this disease. While conducting my
research on this topic, I gained a lot of new knowledge about broken
heart syndrome.
 Body
Main Point Let me start with the causes of broken heart syndrome. The actual
(Point 1) cause of broken heart syndrome is unknown to researchers.
However, they believe physical or mental stressor may cause it.
Some examples of emotional stressors include grief from the death
of a loved one, divorce and extreme anger. Meanwhile for physical
stressors, it may be exhausting physical event and health issue.

When you react to physical or emotional stress, your body releases

stress hormones like adrenaline, noradrenaline, epinephrine, and
norepinephrine into your bloodstream. Experts believe that these
hormones temporarily disrupt the function of your heart. Broken
heart syndrome symptoms might appear minutes to hours after a
stressful event. Stress hormones temporarily paralyze your heart
muscle, causing symptoms comparable to a heart attack.
Description of data
(Chart 1)

Analysis of data The chart shows the occurrence of risk factors for takotsubo
(Chart 1) cardiomyopathy. Based on the chart, hypertension, with 43% of
prevalence, is a common cause of a person experiencing broken
heart syndrome. Following up by smoking and dyslipidemia with
25% of prevalence and diabetes with 11%.
Main Point Let’s move on to the next part which is who is typically diagnosed
(Point 2) with broken heart syndrome. Studies show that broken heart
syndrome mostly affects women rather than men. It is seen in
persons of any age group and gender. However, it is more common
in after menopause females, ranging in age from approximately 65
to 70 years old.

One possible explanation is that the female hormone estrogen

protects your heart against any harmful effects of hormones your
body releases in response to stress. As the level of estrogen
declines with age, women might be more susceptible to the effects
of sudden stress.
Description of data
(Chart 2)

Analysis of data The chart shows the number of patients diagnosed with broken heart
(Chart 2) syndrome according to gender and age. Based on the chart, the
number of female patients is higher than the male, with 1,571
compared to 179. Also, the chart shows that the highest age range
of broken heart syndrome patient is around 75 to 79 years old.
Conclusion
Conclusion In conclusion, broken heart syndrome is a temporary condition for
most people. You’ll likely recover without any long-term heart
problems because your heart muscle doesn’t have permanent
damage. People usually make a full recovery a few days to a few
weeks after the diagnosed. However, we should limit physical and
emotional stress for preventing broken heart syndrome.
Recommendation As for the recommendation, learning stress management, problem-
solving techniques and relaxation techniques like practicing yoga
and meditation can help to limit physical and emotional stress. Also,
healthy habits can help you manage physical or emotional stress
too. These habits may include eating a healthy diet and getting
regular exercise.
 References
Cleveland Clinic Medical Professional. (20 November, 2022). Broken Heart Syndrome. Retrieved
from https://my.clevelandclinic.org/health/diseases/17857-broken-heart-syndrome

D.Derrick. (1 February, 2009). The"broken heart syndrome": understanding Takotsubo

cardiomyopathy. Retrieved from https://www.semanticscholar.org/paper/The%22broken-
heart-syndrome%22%3A-understanding-Takotsubo-
Derrick/d827cef92e7265e952dddf11bcf95aa5e779f876

Jelena-Rima Ghadri, I. S. (May, 2018). International Expert Consensus Document on Takotsubo

Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology.
Retrieved from
https://www.researchgate.net/publication/325499245_International_Expert_Consensus_Do
cument_on_Takotsubo_Syndrome_Part_I_Clinical_Characteristics_Diagnostic_Criteria_an
d_Pathophysiology
 ELC590
ARTICLE 1

Broken Heart Syndrome

Written By Cleveland Clinic medical professional on 11/20/2022

What is broken heart syndrome?

Broken heart syndrome is a temporary heart condition with symptoms like those of a heart
attack. You may think you’re having a heart attack because both conditions cause shortness
of breath and chest pain. However, in broken heart syndrome, you don’t have blocked
coronary arteries or permanent heart damage. And you usually make a fast and full recovery.

Unlike a heart attack, broken heart syndrome happens when a sudden physical or emotional
stressor makes your heart muscle weaken rapidly.

There are many names for and types of broken heart syndrome, including:

• Takotsubo cardiomyopathy.
• Apical ballooning syndrome (or transient apical ballooning syndrome).
• Gebrochenes-Herz syndrome. Stress cardiomyopathy (or stressinduced
cardiomyopathy).

Who gets broken heart syndrome?

According to medical literature, broken heart syndrome (also known as takotsubo

cardiomyopathy) occurs in about 2% of people who visit a provider for a suspected heart
attack. However, researchers believe the true number of cases is actually higher because
providers often don’t recognize the condition.

Broken heart syndrome mostly affects women or people assigned female at birth (AFAB), who
make up about 88% of reported cases. This is especially likely after menopause (mean age
range of 58 to 77).

One possible explanation is that the female hormone estrogen protects your heart against any
harmful effects of hormones your body releases in response to stress. As the level of estrogen
declines with age, women or people AFAB might be more susceptible to the effects of sudden
stress.
How does this condition affect my body?

A weak heart muscle can disrupt your heart’s supply of blood and its pumping ability. If your
heart isn’t pumping effectively, that negatively affects your whole body. Every cell in your body
relies on the steady supply of oxygen that your blood carries.

What causes broken heart syndrome?

Researchers don’t fully understand the exact cause of broken heart syndrome. However, they
believe a stressful event like a divorce, car accident or job loss can cause it. When you react
to physical or emotional stress, your body releases stress hormones in your blood like
adrenaline, noradrenaline, epinephrine and norepinephrine. Experts think that these
hormones temporarily interfere with your heart’s function.

A small percentage of people with broken heart syndrome (also known as takotsubo
cardiomyopathy) can’t identify any stresses that may have triggered their episode.

Broken heart syndrome:

• Disrupts your heart’s normal, steady rhythm (pattern of heartbeats).

• Causes part of your heart to temporarily enlarge (the lower part of your left ventricle).
• Leads to even more forceful contractions in other areas of your heart.

What kinds of emotional and physical stress can cause broken heart syndrome?

Examples of sudden emotional stressors include:

• Grief from the death of a loved one or other large or meaningful loss (relationship,
home, money or a beloved pet).
• Good news (surprise parties, winning the lottery).
• Bad news.
• Intense fear (public speaking, armed robbery).
• Extreme anger.

Examples of sudden physical stressors include:

• Severe pain.
• An exhausting physical event.
• Health issues, including asthma attacks, dibculty breathing (dyspnea), seizure, stroke,
high fever, low blood sugar (hypoglycemia), large blood loss or surgery
What are the signs and symptoms of broken heart syndrome?

You may feel broken heart syndrome symptoms within minutes up to hours after the stressful
event. The release of stress hormones temporarily stuns your heart muscle, producing
symptoms similar to a typical heart attack.

Signs and symptoms of broken heart syndrome include:

• Sudden, severe chest pain (angina) — a main symptom.

• Shortness of breath — a main symptom.
• Weakening of the left ventricle of your heart — a main sign.
• Irregular heartbeats (arrhythmias).
• Low blood pressure (hypotension).
• Heart palpitations. Fainting (syncope).

Can broken heart syndrome be prevented?

There are no known treatments for preventing broken heart syndrome (also known as
takotsubo cardiomyopathy). However, learning stress management and problem-solving
techniques can help you limit physical and emotional stress.

• Relaxation techniques can also be helpful. Some examples include:

• Practicing yoga, meditation, journaling or mindfulness.
• Taking a warm bath.
• Lighting scented candles.
• Taking long, deep breaths and slowly exhaling.

Depending on the source of your stress, you may be able to join a support group to talk about
your stress and share coping skills. A professional counselor can help, too.

In addition, healthy habits can help you manage physical or emotional stress. These habits
include: Eating a healthy diet, such as the Dash diet or Mediterranean diet.

• Getting regular exercise (at least Uve times a week for 30 minutes).
• Getting seven to nine hours of sleep each night.
• Spending time with others.
• Keeping your medical appointments for checkups and screenings.
• Avoiding tobacco product use, recreational drug use and excessive alcohol use. (If you
currently use these substances and want to quit, your healthcare provider can guide
you to helpful resources.)
Does broken heart syndrome heal?

Yes. Broken heart syndrome (also known as takotsubo cardiomyopathy) is a temporary

condition for most people. You’ll likely recover without any long-term heart problems because
your heart muscle doesn’t have permanent damage. People usually make a full recovery a
few days to a few weeks after a stress-induced event.

If an ongoing health problem — like stroke, asthma or seizures — triggered your broken heart
syndrome event, check with your healthcare provider for help managing these health issues.

In some cases, your provider may want to do a follow-up echocardiogram about four to six
weeks after your event. They’ll want to make sure you don’t have any heart health problems
and the left ventricle of your heart is working normally again.
 ELC590
ARTICLE 2

Takotsubo Cardiomyopathy: Medical and Psychiatric Aspects. Role of Psychotropic

Medications in the Treatment of Adults with “Broken Heart” Syndrome

Written by Val Bellman on July 19, 2019

Abstract

Takotsubo cardiomyopathy (TTC) is reversible stress-induced cardiomyopathy featuring

symptoms of acute myocardial infarction without significant coronary artery abnormalities.
TTC is frequently precipitated by stressful emotional events but it also has been reported as
a result of substance withdrawal, non-cardiac events, and dangerous drug-to-drug
interaction. The plasma levels of both epinephrine and norepinephrine were significantly
elevated in TTC patients, suggesting that elevated catecholamine levels might be the main
contributing factor. However, the mechanisms underlying susceptibility to development and
recurrence are not completely understood.

It has been suggested that even a therapeutic dose of antidepressant could be a cause of
drug-induced tachycardia and TTC. Moreover, some cases have been reported in which the
development of TTC was associated with the serotonin syndrome, neuroleptic malignant
syndrome, and similar fatal consequences.

The aim of this article is to explore the association between underlying psychiatric disorders
and TTC and to determine the role of various psychotropic medications in the progression of
stress-induced cardiomyopathy. This article also notes and discusses the current theories
underlying the pathophysiology of TTC. This review suggests a serious side effect of
antidepressants, and to avoid life-threatening cardiovascular events, such as TTC, for
patients with affective and anxiety disorders, prior screening for cardiovascular conditions by
ECG with close monitoring might be necessary.

Introduction & Background

Takotsubo cardiomyopathy (TTC) is characterized by transient apical and mid-ventricular left

ventricular (LV) dysfunction in the absence of significant coronary artery disease. It is triggered
by emotional or physical stress. It shows symptoms that are similar to those of myocardial
infarction (MI), however, it does not occur as a result of any underlying cardiovascular
condition. It is a reversible heart condition, which occurs almost entirely in postmenopausal
women. The condition causes waning of the left ventricle, the main pumping chamber of the
heart. In a setting of depressed distal and apical LV function, there is compensatory
hyperkinesis of basal walls. It was suggested that TTC is associated with extreme emotional
and physical stress. However, the pathophysiology of this condition has not been fully
elucidated. According to preliminary data, catecholamines released from adrenal chromaffin
cells and norepinephrine released from sympathetic nerve terminals are significantly
increased in the acute phase of TTC. Thyrotoxicosis, pheochromocytoma, and several
neuropsychiatric diseases are medical conditions associated with TTC. This article will discuss
these issues and shed some light on the pathogenesis of this syndrome and the role of various
psychotropic medications in the treatment of adults with TTC.

Background

Takotsubo Cardiomyopathy: Definition, Epidemiology, and Statistics

TTC is a cardiac condition that causes an unexpected and momentary waning of the heart’s
muscular section. The weakening of often triggered by emotional stress from situations like
emotional break-ups, the demise of a loved one, or excessive anxiety. It has been recognized
as a leading cause of ventricular ruptures, acute heart failure, and lethal ventricular
arrhythmias. The name of the condition is derived from the Japanese word takotsubo, which
is an octopus trap. The nomenclature relates to the similar shapes of the octopus trap and the
left ventricle.

Before the condition was officially named tako-tsubo, it existed, but the syndrome was
diagnosed differently in different geographical areas. It has been recognized as a severe heart
condition, with similar clinical appearance to other coronary events.

The first case was reported in Japan in 1990. Since the Japanese term was introduced, the
condition has increasingly been noted in the majority of countries. Unlike other
cardiomyopathy conditions, TTC is not known to be inherited.

The prevalence of Takotsubo cardiomyopathy has been reported in 2% of patients with

apparent acute coronary syndrome and 10% of female patients. It is seen in persons of any
age group, however, it is more common in postmenopausal females than in males. Studies
show that 85%-90% of patients with the condition are females ranging in age from
approximately 65 to 70 years old. More specifically, one study shows that 89.8% of recent
cases of the conditions were women with a mean age of 67 years. Despite these figures, TTC
has been reported in people of both genders and from every age group. In men, the
predisposing factor is most likely physical stress or severe medical illness.
In the past, the prevalence of TTC was probably underestimated due to widespread ignorance
of the syndrome. Conversely, with the growing consciousness about the disease and an
overall increase in early access to angiography, the condition is not identified more frequently.
Studies and health reports have identified an increased incidence of TTC. There has also
been an increased hospitalization rate of individuals with TTC.

The number of documented cases has progressively increased since 2001 (Figure 1)

Figure 1: Number of patients with TTC compared with STEMI

TTC: Takotsubo cardiomyopathy; STEMI: ST-segment elevation myocardial infarction

Writers reported a significant increase in the incidence of TTC from 2006 to 2012. In this study,
the incidence of TTC increased almost 20 times during the time period. Results are
summarized in Figure 2.

Figure 2: Trends in reported incidence of Takotsubo syndrome from 2006 to 2012

Modified from a previously published table by Minhas AS et al.
Though the first case was reported in Japan, today, TTC is geographically widespread and
has been reported in all six continents. It has been reported in more than 50 countries with
little variation in its clinical expression. Although there have not been large comparative
studies, preliminary studies show that cases are reported in many races but are less common
among African Americans and Hispanics. A study was also not able to identify significant
differences in clinical manifestations between Caucasian and Asian patients with TTC.
Existing data suggest a temporal pattern of occurrence, as it has been associated with a
circadian effect, with peaks in the morning and lows in the evening. This is associated with the
morning flow of stress hormones and the experience of stressful events at a particular time of
the day.

Risk Factors of Takotsubo Cardiomyopathy

The development of Takotsubo cardiomyopathy is often preceded with significant physical or

emotional stress or neurologic injury. Common stressors include news of the death of a loved
one, financial issues, natural disasters, legal problems, motor vehicle accidents, long stays in
intensive care units, a recent medical diagnosis, and substance withdrawal from substance
abuse, among others. TTC is also seen with seizure activity. Though the clinical presentation
is often similar to that of other cardiac conditions, it can be differentiated through
ventriculography used together with echocardiography. In most patients, it is clear that
physical stressors are the most common causes, as opposed to emotional stressors, while a
significant portion of patients did not have clear triggers. Most affected people also psychiatric
or neurological conditions.
 ELC590
ARTICLE 3

Takotsubo Cardiomyopathy
Written by Ghadri JR, Wittstein IS, Prasad A on March 31, 2020

Summary

Takotsubo cardiomyopathy is a heart disease characterized by transient dysfunction and

ballooning of the left ventricle of the heart. It mostly affects elderly women and is often
triggered by severe physical or emotional stress. The symptoms are similar to those of a heart
attack (myocardial infarction) and include chest pain, difficulty breathing (dyspnea), and
sometimes transient loss of consciousness (syncope). Although complications can occur,
most individuals fully recover within one month. The treatment of takotsubo cardiomyopathy
is focused on symptom control and the prevention and treatment of associated complications.

Introduction

The role of the heart is to act as a pump to make sure blood is appropriately oxygenated and
able to feed the body. The heart as four chambers: two small atria (left and right), which are
located on top of the heart, and two larger ventricles (also left and right), which are located
below the atria and act as the main pump of the heart. Blood flows in the body the following
way: 1) Blood in the left ventricle is ejected into the aorta, which redistributes oxygenated
blood throughout the body 2) Oxygen in the blood is extracted by organs and deoxygenated
blood comes back in the right atrium of the heart via the veins 3) Deoxygenated blood in the
right atrium falls into the right ventricle 3) Deoxygenated blood is ejected from the right
ventricle into the pulmonary arteries, where it will be able to take oxygen from the lungs 4)
Oxygenated blood comes back to the left atrium via the pulmonary veins 5) Oxygenated blood
in the left atrium falls into the left ventricle of the heart, where the cycle can start again.

Takotsubo cardiomyopathy is a type of disease of cardiac muscle (cardiomyopathy) that is

characterized by dysfunction and ballooning of a portion of the left ventricle of the heart, most
often its tip (apex). It was first identified in Japan in the 1990s and was named after Japanese
octopus traps (takotsubo) that are shaped similarly to the heart of affected individuals. Since
that time, the condition has been recognized in individuals all over the world.
Synonyms

• takotsubo syndrome
• broken heart syndrome
• stress cardiomyopathy
• ampulla cardiomyopathy
• apical ballooning syndrome

Signs & Symptoms

Takotsubo cardiomyopathy can occur in adults of any age, but most often develops in elderly
women. The most common symptoms are the abrupt (acute) onset of crushing chest pain and
difficulty breathing (dyspnea). Anxiety, sweating (diaphoresis), nausea, vomiting, palpitations,
and transient loss of consciousness (syncope) can also occur.

Most individuals that develop takotsubo cardiomyopathy fully recover within one month, and
recurrence is rare. However, complications occur in about 20% of patients. In some
individuals, the heart might be unable to pump blood efficiently (heart failure), which can lead
to fatigue, dyspnea, and leg and abdomen swelling due to fluid accumulation (edema). In
severe cases, cardiac dysfunction might prevent organs from receiving adequate oxygen
supply (cardiogenic shock). Takotsubo cardiomyopathy can also lead to an irregular, too fast,
or too slow heartbeat (arrhythmia). Another possible complication is pooling of blood in the
heart, which promotes clot formation. These clots can be expulsed from the heart and lodge
into arteries of the brain, which can lead to a stroke. Despite the possibility of complications,
more than 90% of affected individuals survive takotsubo cardiomyopathy.

Causes

The mechanism by which takotsubo cardiomyopathy develops in not entirely understood. In

about 2/3 of cases, the disease is preceded by intense emotional stress (such as divorce,
death of a loved one, or bankruptcy) or physical stress (such as a stroke, fracture, or infection).
A hypothesis is that these stressors lead to the release of large amounts of adrenaline
(epinephrine) and other stress-related hormones collectively known as catecholamines. This
surge of hormones might lead to spasms of the blood vessels and disruption of the ventricles
of the heart, which would be responsible for the ventricular dysfunction and ballooning seen
in takotsubo cardiomyopathy.
Affected populations

Takotsubo cardiomyopathy can develop in men and women of any age and ethnic
background. However, about 90% of affected individuals are women, and 80% are women
over the age of 50. The exact frequency of the disease is not known and might be
underestimated, but is thought to comprise approximately 2% of all individuals (and up to 5%
of women) with suspected ST-segment elevation myocardial infarction, which is the most
severe type of heart attack. This represents more than 4000 individuals in the United States.
 ELC590
GRAPHS/CHARTS

Chart 1

Chart 1 The occurrence of risk factors for

Takotsubo Cardiomyopathy

Chart 2

Chart 2 The number of patients diagnosed with broken

heart syndrome according to gender and age