Apical ballooning syndrome or stress cardiomyopathyis a temporary condition of heart that happens due to various stressful situations like the death of a loved one. People who suffer from apical ballooning syndrome or stress cardiomyopathy may experience catastrophic chest pain or feel like they are experiencing a heart attack. The normal function of pumping is disrupted and the heart functions with forceful contractions that are abnormal.

Apical Ballooning Syndrome or Stress Cardiomyopathy

Apical ballooning syndrome or stress cardiomyopathymay result from the reaction of heart due to various stress hormones. The condition can also be called as broken heart syndrome, takotsubo cardiomyopathy or stress cardiomyopathy by medical practitioners.

The symptoms of this syndrome can be treated and the condition is reversed automatically in a week.

The Causes of Apical Ballooning Syndrome or Stress Cardiomyopathy

The precise cause of apical ballooning syndrome or stress cardiomyopathy is uncertain. It has been determined that surging of certain stress hormones may be the cause of such heart damages in some kind of people. However, the process through which it is caused has not been completely speculated. Constriction in the small or large heart arteries may contribute to such heart damages.

Apical ballooning syndrome or stress cardiomyopathy often follows an emotional or intense physical situation. Some possible triggers are mentioned below:

  • A sudden death of any loved one
  • Domestic abuse
  • Divorce
  • A frightening medical diagnosis
  • Losing a huge amount of money
  • Natural disasters
  • Having to perform publicly
  • A surprise party
  • Job loss
  • Physical stressors like a major surgery, an asthma attack or a car accident.

It is also possible that certain drugs can be the cause of apical ballooning syndrome or stress cardiomyopathy. This may be because of the surging of stress-causing hormones. The following drugs may cause apical ballooning syndrome or stress cardiomyopathy.

  • Epinephrine (EpiPen, EpiPenJr) is used for treating severe asthma attack or allergies
  • Duloxetine (Cymbalta) is used for treating nerve problems in the diabetic people or for treating depression.
  • Venlafaxine (Effexor XR) is used for treating depression.
  • Levothyroxine (Synthroid, Levoxyl) is given to those with problems in thyroid glands.

How is Apical Ballooning Syndrome or Stress Cardiomyopathy Different from a Heart Attack?

When heart artery is completely or nearly completely blocked, heart attacks can be caused. The blockage can be caused due to accumulation of fats in the artery walls that may lead to the formation of blood clots. In apical ballooning syndrome or stress cardiomyopathy, the blood flow is reduced in the heart but the arteries do not get blocked.

I Am Under Lot of Every Day Stress. Is It Possible That I have Apical Ballooning Syndrome or Stress Cardiomyopathy?

Even though the effects of stress have not been known on humans, apical ballooning syndrome or stress cardiomyopathy is a condition that comes suddenly and quickly resolves. If you suffer from frequent chest pain or have shortness of breath, then you should get yourself evaluated by a doctor. The doctor may undertake some tests to determine your health. If the symptoms have been persistent, chances are that you are suffering from stress cardiomyopathy.

Once a Person has had Apical Ballooning Syndrome or Stress Cardiomyopathy, What are the Chances of Re-Occurrence?

There are very little chances of suffering from apical ballooning syndrome or stress cardiomyopathy once it has been treated. This has been reported by several doctors who have treated patients suffering from apical ballooning syndrome or stress cardiomyopathy.

Symptoms of Apical Ballooning Syndrome or Stress Cardiomyopathy

The symptoms of apical ballooning syndrome or stress cardiomyopathy can be similar to a heart attack. Some of the below-mentioned symptoms are commonly seen:

  • Chest pain
  • Shortness of breath.

When chest pain is persistent, it may be a sign of heart attack, so be sure to dial 911 when you experience sever pain.

Risk Factors for Apical Ballooning Syndrome or Stress Cardiomyopathy

Women are affected more by apical ballooning syndrome or stress cardiomyopathy than men. The age group that is affected by it the most is 50 or more.

Complications for Apical Ballooning Syndrome or Stress Cardiomyopathy

There are rare cases in which apical ballooning syndrome or stress cardiomyopathy is lethal. Nevertheless, people who suffer from it recover quickly and the side effects do not show as well.

Apical ballooning syndrome or stress cardiomyopathy may show some of the following complications:

  • Pulmonary edema or backup of fluids in the lungs
  • Hypotension or low blood pressure
  • Irregular heartbeats

A person may suffer from apical ballooning syndrome or stress cardiomyopathy if any other stressful events occur in the future. However, the chances of its recurrence in the future are quite low.

Tests to Diagnose Apical Ballooning Syndrome or Stress Cardiomyopathy

The following examinations or tests may be done to diagnose apical ballooning syndrome or stress cardiomyopathy if your health practitioner may suspect you with the condition.

  • Physical exam and personal history. Apart from the basic physical examinations, the doctor may try to know more about the medical history and determine whether you were suffering from any kind of heart diseases. Normally, there are no associated signs of heart diseases in people who suffer from apical ballooning syndrome or stress cardiomyopathy. Along with it, the doctor will also try to know about any stressful events that have taken place in your life.
  • Electrocardiogram (ECG) Test. This test is noninvasive and a technician may keep certain wires on the chest to record the heart beat via electrical impulses. This will help the doctor in knowing about the irregularities in the heart beat and its structure as well.
  • Chest X-ray. A chest X-ray will be ordered by your doctor to speculate any kind of enlargement in the heart or if there is a sign of apical ballooning syndrome or stress cardiomyopathy. This may also show any abnormalities in the lungs that may be causing the signs for the syndrome.
  • Echocardiogram. An echocardiogram may be ordered to see any kind of abnormal enlargement in the heart that may be a sign of the syndrome. This exam is also noninvasive and includes taking chest ultrasounds that shows a detailed image of the heart in all terms. A transducer is used for recording the heartbeats and this is done by capturing the ultrasound waves. The information that the transducer sends will be used for creating certain images on the computer.
  • Blood tests. People who are suffering from apical ballooning syndrome or stress cardiomyopathy show elevated amounts of definite enzymes in blood. The doctor may also ask you to take blood tests for checking the amount of enzymes that can help in the diagnosis.
  • Coronary angiogram. In this type of examination, a certain dye is injected into the heart blood vessels. This is done using the help of an X-ray that takes images of the heart rapidly. The doctor then magnifies the blood vessels and examines it thoroughly. The sufferers of apical ballooning syndrome or stress cardiomyopathy do not show any kind of blockages while the ones that have heart attack will show blood vessel blockage.

Treatment for Apical Ballooning Syndrome or Stress Cardiomyopathy

The treatment of apical ballooning syndrome or stress cardiomyopathy does not have standard guidelines of treatment. As long as the diagnosis is not done, the treatment approach may be unclear. Some people are asked to accommodate in hospital until the recovery period.

Once the syndrome has been clearly determined from the symptoms, the doctor will prescribe various medications that have to be included in your daily routine. This may include diuretics, angiotensin-converting enzyme (ACE) inhibitors or beta blockers. These will help in reducing the load on the heart and help in recovering at a faster rate while preventing any attacks in the future. The patient may completely recover in a month or two. Always speak to your doctor about the medication course as it will have to be stopped after a point of time. The exact reason for the chest pains may be determined with the help of coronary angiography.

Prevention of Apical Ballooning Syndrome or Stress Cardiomyopathy

The recurrence of apical ballooning syndrome or stress cardiomyopathy is very rare once it has happened in the earlier times. There is no therapy for preventing the occurrence of such episodes but the doctors may prescribe taking beta blockers for a long time. These medications will help in reducing the impacts of stress on the heart that can cause apical ballooning syndrome or stress cardiomyopathy. Managing and understanding about the stress is of prime importance to save yourself from the damages of heart diseases.

Prognosis for Apical Ballooning Syndrome or Stress Cardiomyopathy

Complete and rapid recovery from this syndrome is possible as the muscles of the heart are not permanently or entirely damaged. An excellent way to combat the stress on the heart muscles and aid in faster recovery is through yoga and exercises which relieves day to day stress. The prognosis of apical ballooning syndrome or stress cardiomyopathy is good in a long time.

Lifestyle Changes for Apical Ballooning Syndrome or Stress Cardiomyopathy

It is extremely important to find various ways to reduce the impact of stress and adjust with the situations that upset the mind and the heart. It is essential to learn managing stress, relax at hard times and cope with the issues. This can help in improving the physical and emotional health to a huge extent.

Having support from your loved ones in life can be a great stress buster. Medicine, various physical activities and relaxation therapy can help in relieving stress as well. You may also participate in stress management programs for learning to manage stress in a healthy manner.

Note: Treatments Which not Helpful for Apical Ballooning Syndrome or Stress Cardiomyopathy

Quite a few methods are used for treating heart attacks and they do not prove to be of any help in the treatment of apical ballooning syndrome or stress cardiomyopathy. Percutaneous coronary intervention (also called as angioplasty at times), surgery for treating artery blockages and stent placement are not helpful in case of apical ballooning syndrome or stress cardiomyopathy.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: April 1, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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