Can You See a Doctor About a Broken Heart? with Dr. Joy Gelbman

 

Welcome to Health Matters – your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Faith Salie.

Are those chest pains signs of a heart attack or… a broken heart? 

Broken Heart Syndrome is a real cardiac event spurred by an intense emotional reaction to life events. 

In honor of Valentine’s Day, I spoke with Dr. Joy Gelbman, Cardiologist at NewYork-Presbyterian and Weill Cornell Medicine about how the heart is a physical and emotional center of our body.

Faith: First off, happy Valentine’s Day, Dr Gelbman.

Dr. Gelbman: Thank you so much. To you as well. Happy Valentine’s Day.

Faith: This is the perfect day for you to join us and shed some light on all things heart.

Dr. Gelbman: I’m happy to.

Faith: Why do you think that the heart is associated with strong emotions like love?

Dr. Gelbman: Of course I’m a little bit biased as a cardiologist in that I think that the heart is sort of the center of the body. It’s where all blood flows through and so, it’s not uncommon for people to experience all these idioms about the heart being set aflutter. 

Faith: I mean, most of us, it, the heart is inextricable from the notion of love. As a cardiologist, what does the term full heart mean to you?

Dr. Gelbman: Full heart to me means, sort of, giving everything you have emotionally to something. So whether it’s loving with your full heart or trying with your full heart or, it’s just approaching anything, wholeheartedly. It sort of means to give all of your emotional strength to that process.

Faith: And I’m sure as a cardiologist, that makes sense to you because you can’t give all of yourself if your actual heart muscle is not working at its full capacity.

Dr. Gelbman: Right. That is why it is so important to really focus on heart health, because it has not only the physical consequences, but also, as you led with, it’s the emotional center too.

Faith: So I love a metaphor, like I have an unholy love for metaphors, I can dig into them forever. And yet, I think I’ve heard that a “broken heart syndrome” is a real medical, physical thing? Is this true?

Dr. Gelbman: This is true. I think most of your listeners probably think about a broken heart as a trauma that somebody might go through when they break up with a, with a partner or lose a loved one that you really feel like your heart is, is broken. 

Faith: Yeah.

Dr. Gelbman: But there actually is a true medical condition that also goes by the term broken heart syndrome.

Faith: Is there a fancy medical name for it?

Dr. Gelbman: Well, the medical term that we often use is called stress induced cardiomyopathy, but a more fun term that’s also associated with this condition is called “Takatsubos.” 

And the reason for that is because this condition was first described in Japan in the nineties. And apparently, and you can Google this, there is a special kind of pot that Japanese folks, and I guess others, use to catch octopi.

And it’s, it’s sort of narrow at the top and balloons at the bottom which I guess makes it so that an octopus can swim in, but maybe not swim out. But it actually looks just like the way a heart looks when it is stricken with this condition.

Faith: I love a history/biology nugget. Thank you. Thank you for that. I love that. So, how does it feel to have broken heart syndrome, a stress induced cardiomyopathy? 

Dr. Gelbman: It presents almost identically to a person having a heart attack. There’s sort of an umbrella term for people who present with cardiac type syndromes called acute coronary syndrome or ACS. And about 1-2 percent of those presentations turn out to be broken heart syndrome.

And so, for all intents and purposes, it looks just like you’re having a heart attack. You might have chest heaviness, or pressure, or you’re, you know, short of breath. The main difference though is that these people, and sort of one of the hallmark features of the diagnosis, is they don’t actually have coronary artery blockages. And this phenomenon is typically triggered by some kind of emotional stressor.

Personally, I’ve seen it in a patient who lost a loved one. I had a grandma who was watching her kids at the beach and one of them almost drowned. You know, these can be a sort of a job stress or a financial stress but it’s typically that, there’s some emotional trigger that sets this off and that’s also sort of part and parcel of the diagnosis.

Faith: So a patient would present in the hospital having some cardio stress, and then a doctor can only determine that it’s not a heart attack by running tests and looking and saying, “Hey, it doesn’t appear that there’s anything wrong with your heart, except that it looks like an octopus trap right now.” So, so – I’m, ‘I’m here to tell you this is not a heart attack but this is a different kind of condition?’ Is that how it works?

Dr. Gelbman: Yeah, so basically, the, the way to make a diagnosis is, taking the clinical context, of course, but also take taking some diagnostic testing, and, and really what we usually see is we do imaging of the heart that shows this sort of transient ballooning of the apex of the heart muscle. 

We usually see changes on the EKG; that’s that sort of paper that we print out after we put the electrodes on the chest. We may see elevations in the cardiac enzymes, the blood markers. But the key is really to demonstrate somehow, usually by a test called a cardiac catheterization, that there are no- no blockages to account for this complex of signs and symptoms. 

Faith: I would imagine patients and their doctors are relieved to find out that something is broken heart syndrome. I was going to say merely broken heart syndrome, but this needs to be taken seriously.

Dr. Gelbman: Well, I think, yes, I think you’re right. I think patients are relieved to hear that they don’t have any blockages, that they don’t need a stent or bypass surgery. That being said, patients can get pretty ill from it. They can go into congestive heart failure or cardiac shock. And so, it can be quite serious.

Faith: And of course, the underlying cause remains.

Dr. Gelbman: Right.

Faith: Even if it’s not a heart attack, you’re still dealing with a terrible emotional blow.

Dr. Gelbman: Yes, but I will say in most cases, the heart muscle will recover. And the treatment is really supportive care, you know, just trying to get a patient through it with whatever medications that they might need. But generally, the condition will improve within a few weeks. 

That being said, it can recur. You know, once this happens to you, it sort of is a signal that you might be a person that this can happen to. And so there is, you know, a small percent, of – of recurrence, in this condition.

So, yes and no. I think people are relieved to some extent to have this kind of diagnosis, but still, you know, need to be vigilant and can – it can take some time to get better.

Faith: For the most part, what you’re describing is this very discreet experience that seems to largely be brought on by emotional surprise and stress. And there’s something incredibly poignant about that.

Dr. Gelbman: It really is. And also just taking care of these patients. You know, patients who are already going through something intensely emotional, then to have this happen on top of it. I mean, imagine you’re, you know, you get admitted to the hospital with this and you’ve just lost your spouse or, you know, it can be challenging.

And when taking care of these patients, you really have to be patient centered and think about the whole, the whole patient. It’s important to remember that always, but particularly in this instance.

Faith: Yes. And it – and it makes me think, I don’t know that this is a medical evaluation, but when you think about coexisting conditions, it makes me think about loneliness. You know, a broken heart can lead to loneliness and feelings of isolation. How does loneliness impact heart health?

Dr. Gelbman: You know, I’m so glad you brought that up. I would say social isolation and loneliness are known to increase the risk of heart disease and stroke. In fact, you know, maybe you’ve heard it be, heard it said that loneliness is the new smoking, as far as risk factors that – or I think first it was smoking, sitting was the new smoking, [in unison] now loneliness is the new sitting.

Faith: Yeah. Yeah. Yeah.

Dr. Gelbman: All of them are bad. But the, you know, the, the point of saying that is that, you know, it can increase your risk of heart disease to the same extent that smoking can, you know, is up to sort of around 30 percent or so. 

Faith: It also occurs to me that, you know, talking about the connection between loneliness and social isolation and heart health, all these things are correlated, that if you don’t have a lot of interactions with other people or you’re feeling lonely and not motivated to go out in the world, you’re also not moving your body physically in a way that’s good for your health. You might stop taking care of yourself as far as giving yourself the nutrition that your heart needs.

Dr. Gelbman: Right.

Faith: There are a lot of tentacles of this.

Dr. Gelbman: Yeah, it’s a slippery slope. It’s, as you say, you’re feeling lonely, you don’t go out, maybe then you don’t- then you gain weight, then you get deconditioned, then you try to go out and you feel short of breath.

Faith: How can someone improve their social connections to decrease the feeling of loneliness?

Dr. Gelbman: I think for you and your listeners, especially now on a holiday like Valentine’s Day, you know, it’s a good time to check in with your people, with your loved ones, you know, let them know you care about them.

Pick up the phone and call them. I think that, you know, in this day and age people are busy, people maybe think a text is adequate, people don’t really take the time to connect. In fact, I think there was a study not too long ago that showed that Gen Z is actually – even though the risk of loneliness historically has been thought to be higher as you age, you know, certain life events, retirement and widowhood – but Gen Z, I think there was a study that showed that they were the loneliest generation.

Faith: At the same time, they’re the “most connected” with air quotes.

Dr. Gelbman: Right, right, connected to what, right, to their technology, not to other people, in real meaningful ways, you know what I mean? Maybe they have 10,000 followers or friends or whatever the terminology is for whatever social media…

Faith: Yeah, a heart, or a like button will never replace a hug.

Dr. Gelbman: Yes.

Faith: But I, by the way, I’m emboldened to say this because it’s Valentine’s Day, I’m a big hugger. I always ask consent, but I’m very pro hugging, giving and receiving. 

Dr. Gelbman: I think it’s good. Tell people that you’re doing it for their health!

Faith: Yeah, heart to heart.

Dr. Gelbman: So, so I do think as far as what, what a person themselves can do, that’s trickier, right? To try to find connection, force yourself to go out, you know, pick up the phone yourself.

Faith: I mean, I can’t help but come back to toward the beginning of our conversation where we associate the heart with love. Surround yourself with love as much as possible, right?

Dr. Gelbman: Surround yourself with love…

Faith: Make your connections real.

Dr. Gelbman: Right, exactly. The same amount of time that you’re giving to your work or to your finances or thinking about, you know, whatever it is in your life. Really take that same amount of time to let people know that you care about them, getting together with people.

I mean, for, as far as stress reduction goes, you, laughter, you’ve probably heard that can lower risks of stress, mindfulness, getting good sleep. All of those things are really important to maintaining good heart health.

Faith: Dr. Joy Gelbman, I have loved this meeting of joy and faith! And if I could give you a hug, I would. So, thank you so much for joining us.

Dr. Gelbman: My pleasure. My pleasure. Happy to be a part of it. Enjoy the holiday. 

Our many thanks to Dr. Joy Gelbman.

I’m Faith Salie.

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