what is broken heart syndrome

>>> as we celebratevalentine's month, have you ever wondered how serious abroken heart can be? stay tuned for healthwatch.captioning provided by caption associates, llccaptionassociates.com \m\m>>> hello, i'm terrance afer-anderson, and this ishealthwatch. i'm wearing my favorite redtie and suit today because during the month of february,the american heart association celebrates national heartmonth.

of course, it is also go redfor women month, recognizing women and heart disease.did you know that heart disease is the number onecause of death in american women?let me ask you something: have you ever heard of anyonedying from a broken heart? is it really possible?well, you might be surprised to know that there is agenuine medical condition known as broken heartsyndrome. the clinical term isstress-induced cardiomyopathy.

or takotsubo cardiomyopathy.in case you're wondering, a takotsubo is a japanesedesigned pot-shaped octopus trap that closely resemblesthe shape of a human heart when it is in grave distress.when someone suffers a classic broken heart, having beenemotionally stricken by the loss of someone dear, it canactually impact the health of their human heart.there are clear links between depression, mental health andheart disease. the american heart associationtells us that will are more

likely than men to experiencethe sudden, intense chest pain associated with an emotionallystressful event. it could be the death of aloved one, a divorce, a breakup, or a physicalseparation, betrayal, or even romantic rejection.yet it doesn't have to be a disheartening event.it could even happen after an incredible and unpress debitedpositive experience, such as winning the lottery.in those instances the chest pain that is experienced isthe reaction to a great surge

of stress hormones.the american heart association tells us that broken heartsyndrome can be misdiagnosed as a heart attack.this is because the symptoms and it he is results are sosimilar. a broken heart syndrome canyield dramatic changes in heart rhythm, as well as bloodmarkers typically evident in a heart attack.however, unlike a heart attack, there is no evidenceof blocked arteries. in broke p heart sin droll, apart of your -- syndrome, a

part of the heart en larjs anddoesn't pump well, while the rest of the heart functionsnormally or perhaps with even more forceful contractions.today in healthwatch, we'll have heartfelt discussions onaffairs of the heart, more specifically the healthaffairs of the heart. and to help us navigatethrough this discussion, i brought on board the mostknowledgeable cardiologist i know, dr. keith newby,president and founder of fort norfolk plaza medicalassociates.

a native of hammon roads,dr. nub use received a -- newby received a bachelor ofscience from norfolk state university and later a doctorof medicine drooeg from the eastern virginia medicalschool. completed an internship andresidency at the emory university school of med siband completed a fellowship in clinical training incardiology with he will fa sis in invasive electro physiologyat duke medical center. dr. newby is board certifiedin vard yo -- cardiovascular

disease and cardiacelectrophysiology. but what is most impressiveabout the doctor, is that he is very active in thecommunity. for example, he is currentlyworking on a foundation that will educate local residentson how to increase their lifespans while strengtheningfamily by educating communities and providing themwith the tools they need to decrease the effects and onsetof cardio afer-anderson.this is healthwatch.

i'll wearing my favorite redtie and suit today because during the month of februarythe american heart association of course, it is also go redfor women month. recognizing women and heartdisease. did you know that heartdisease is the number one cause of death of americanwomen? let me ask you something.have you ever heard of anyone dying from a broken heart?is it really possible? well, you might be surprisedto know that there's a genuine

medical condition known asbroken heart syndrome. the clinical term isstress-induced cardiomyopathy takotsubo is a heart-shapedoctopus trap, closely resembles a human heart ingrave distress. when someone suffers a classicbroken heart, having been emotionally stricken by theloss of someone dear, it can actually impact the health oftheir human heart. there are clear links betweendepression, mental health and heart disease.the american heart association

tells us that women are morelikely than men to experience the sudden, intense chest painassociated with an emotionally stressful event.it can be the death of a loved one, a divorce, a breakup orphysical separation. betrayal, or even romanticrejection. yet it doesn't have to be adisheartening event. it can happen after anincredible and unprecedented positive experience, such aswinning the lottery. and in those instances thechest pain experienced as a

reaction to a great surge ofstress hormones. the american heart associationtells us that broken heart syndrome can also bemisdiagnosed as a heart attack.this is because the symptoms and test results are sosimilar. attack, there's no evidence ofblocked arteries. broken heart syndrome, a partof your heart temporarily enlarges and doesn't pumpwell. while the rest of your heartfunctions normally, or perhaps

with even more forcefulcontractions. so today on healthwatch, weare going to have heartfelt discussion on affairs of theheart, more specifically, the health affairs of the heart.and to help us navigate through this discussion, ibrought on board the most knowledgeable cardiologist iknow, dr. keith newby, president and founder of fortnorfolk plaza medical associates.a native of hampton roads, dr. newby received a bachelor ofscience in biology from

norfolk state university, andlater earned a doctor of medicine degree from theeastern virginia medical school.he completed an internship and residency at the emoryuniversity school of medicine. and completed a fellowship inclinical training at cardiology, with emphasis ininvasive electro physiology at duke medical center.dr. newby is board certified in cardiovascular disease andcardiac electro physiology. but what i also personallyfind most impressive about dr.

newby is that he is veryactive in the community. lifespans, while strengtheningfamilies by educating communities and providing themwith the tools they knead to decrease -- need to decreaseboth the effects and the onset of cardiovascular disease.it gives me great pleasure to introduce dr. keith newby.welcome to healthwatch. >> thank you very much.>> second time you have been on the show.>> yes. always enjoy coming back andseeing you.

>> i am glad we have theentire show with just yourself, sir.>> thank you very much. >> we are going to talk aboutbroken heart syndrome and generally cardiac health.but i'm very, very impressed with your facility, the fortnorfolk plaza medical center. it is a fairly new facility.if you can tell us a little bit about the facility, whereyou are located, and contact information all of that.>> briefly, the facility was developed really back in 2006,i put together some ideas of

creating an all-inclusivefacility. of course that was 2008 waswhen we actually got the loan approval, right during thattime of the stock market crash.it was a little interesting trying to get financing duringthat time, but through diligence and perseverance wewere able to achieve that goal.so it is really 200,000 square foot facility.actually right across from sentara general hospitaladjacent to the public health

building, one of yourfacilities. river view avenue.so 501 -- sorry, 301 river view avenue, suite 500, wherewe're located. but our contact number is ofcourse 757-624-1785. >> you know, what i reallylike about -- we talk of course about your building --we park at your building, but i directed a show at thepeninsula, i live this in portsmouth now, and whenever iwas coming back home, i take 164, and i am not sure if youare aware of this, but at

night, you can look across theharbor and see your building all lit up in the night.it is beautiful. just absolutely beautiful.>> we had a very good architect, willy cooper, agood friend of mine. we went through the process totry to get the building you. -- building up.he designed that to bring that out at night.it was good, a nice touch. >> great lighting.absolutely. >> thank you.>> i talked about broken heart

syndrome earlier.and of course there's heart attack.can you tell us a little bit more about the differencebetween the two. >> essentially you talk abouta heart attack, you are talking about a true owecollusion of blood flow of art kiss that -- arteries thatsupply blood to the heart muscle itself.a a look at any other muscle, it requires oxygen authorizedto function. and the heart, although it isa pump that pull ps blood to

the other -- pumps blood tothe other muscles, it needs its own blood supply as well,and that's achieved through the coronary arteries.so when you have an obstruction of blood flow to acoronary artery, that's where a heart attack occurs.>> right. >> it has to be a totalobstruction. talking about broken heartsyndrome, actually had personal experience with this,i have had several patients who had that, where you willfind that there is no true

obstruction.they will have all the signs, they will have ekflg changes -- ekg changes, symptoms.and many times you will test the blood, and you will getrises in enzymes, which is really what we use to diagnoseheart attacks. they will all be up.but when we do diagnostic catheterization and look atthe arteries, they are totally clear.>> interesting. >> you will see wall motionproblems where there's areas

of the heart that don'tfunction well compared to the other areas, where you knowsomething happened, but it just wasn't any trueobstruction that caused that to occur.>> amazing. >> i tell you, it is really --the upswing of it all is that when you have somebody likethat, their longevity, as long as you get them, you know, youalmost treat them the same as if you would a haerltattack -- heart attack from blood thinners and betablockers and other things we

normally do oxygen, you know,sometimes morphine. we treat them all the same,and the outcome is excellent. as long as you get them early,get people treated appropriately, just like anyother entity, the biggest problem we run into, gettingpeople to come to the hospital to get assessed.you know, they think it's gas or something else, andsometimes they can die at home from that.>> from broken heart syndrome. >> from broken heart syndrome.>> you mentioned ekg.

>> is there any difference atall, are they -- >> well, you'll findvariables. even in, say, obstructiveheart attack, you may not always see the classicekg exchanges suggestive of such.meaning, you know, there are different types of heartattacks. you have your stfl elevation,you look at the ekg, classic findings.then you have something called a non-st elevation heartattack.

st segment is part of theekg tracing. >> i see.>> so if that -- you know, you will find some heart attacksthat won't have the st segment elevations.so the ekg is a good diagnostic tool, but i tellyou, you know, even during this testing environment wherewe've gotten away from the basics of medicine, which isthe clinical acumen, i still say that's the best.you have to take everything into context.as an example, you know, you

have, say, a 20-year-old youngwoman that comes in with symptoms of chest pain.you know, characteristically the likelihood of her havingan st elevation myocardial infarction is low.not to say impossible, but it is low.take it the other side, a 65-year-old woman who smokesand has multiple other risk factors -->> i'm sure we'll talk about that as we go along.>> you are going to look at that person with a morecareful eye, because you know

there is a higher likelihoodthey actually are going to have heart disease.>> um-hum. >> so it is all about thediagnostic acumen, or your ability to look at a patientand say, okay, what is the likelihood that this personhas disease. and then you go after it.we take everybody seriously. i'm a firm believer in everypatient that hits the emergency room doors that i'mprivy to see is going to get treated the same, because younever know until you know, but

what we have to look at islikelihood. and that's the part i'mtalking about, more statistically, what is thelikelihood this person has disease?because you don't want to do heart catheterizations oneverybody, because there are some intrinsic risks.you want to make sure you carefully select those peoplewhen you are trying to figure out what is the best modalityto figure out what is going on with the patient.>> you mentioned the

treatment.and the beta blockers and so forth.you know, this makes an ideal time to talk about that.and i want to concentrate more on typically heart attack andcardiovascular disease. last question about brokenheart syndrome. so there is a difference inthe treatment modality -- >> to a certain degree.the only real difference is the ultimate treatment, if youneed to open a vessel, meek, say, somebody -- meaning, saysomebody is having a heart

attack.that typically means the vessel is closed.we take them to the heart catheterization labs, do adiagnostic heart catheterization, inject dyematerial, look at the vessels and see if they have blockage.if they do, we will typically use balloon-type technologywith stenting and open the vessel up to get more flow tothe area of the heart. in the situation, somebodyneeds bypass surgery emerge ntly, we'll send them forbypass surgery.

with broken heart syndrome,they don't have the blockages. all the pre-treatment is thesame, meaning get them in, give them aspirin, betablockers, give them oxygen, going to use morphine if needbe, because that does relax the patient and does relax thecoronary artery. >> beyond just the pain.>> yes, it does have other responses.so all these things are beneficial to the patient.then blood thinners of course. so you treat everybody beforethe final diagnosis the same,

just what happens after that.do they go to the heart catheterization lab, do youfind blockage, or do you find really there's nothing there.and in those situations, and i think a lot of the problem is,there is noted increased stress hormone levels that youwill see in broken heart syndrome that norepinephrinelevels are elevated. the body normally makes those,but in stressful situations they can increase four-fold.they cause vasvm al -- vasal constriction.when you get an artery that

con strikts down, the flow notgetting down to that artery into the area of the muscle ofthe heart that's trying to supply.so you will have people who have this broken heartsyndrome that they will get obstruction of flowtemporarily, but that's because of vasal spasm, thenthe vessel relaxeses, and more flow to the heart.which could account for why that area of the heart doesnot move or function compared to the other parts of theheart.

but once you reestablish bloodflow -- almost like the heart becomes stunned for a while.just like anything else. if i put a blood pressure cuffon your arm and pump it up, your arm will start to hurt.why is it hurting? because i'm cutting off bloodflow to that area of the heart.if i were to pump it up and leave it there for fiveminutes and then release the air, before you end up hittingme for leaving it up so long, you will probably notice it isgoing to take a while for the

numbness to go away in yourarm. it will eventually go away,but it will take a while. but that's because you cut offblood flow for an amount of time.>> recirculate. >> yes.>> and that is the instance where -- in some instances youmight use a balloon. >> not necessarily.>> in the broken heart, typically not.by the time you get into the lab, you will inject dye, youwon't see any blockages at

all.a lot of times vessels have relaxed by that time.and that's theoretical. we've never actually -- imean, i've seen coronary is spasm before, but not in theface of the broken heart syndrome.characteristically the way we handle heart issues, the firststep is always stabilization as best you can.you want to get people on the right medications because youwant -- look at it as an example.they have a heart attack, that

means they have a clot intheir heart. that area is unstable becauseof the lack of blood flow. and that's whu -- when youstart getting heart rhythm disturbances and things thatcan cause death. so you want to try toalleviate that stress level, and with that -- thoseincreased hormone levels, those can also lead to heartrhythm disturbances. so just like beta blockers areused to decrease that stimulating event that thosecatacolamines give.

beta blockers he to slow theheart rate down and takes away the extra stress.aspirin is an anti-platelet drug, keeps them from clumpingtogether. so at this ikly use thingslike heparin, another type of iv blood thinner, designed tostabilize situations, decrease clot burden, and hopefullydecrease the response that the heart has to those increasedkrfl atacolamines. so the treatment strategiesare typically the same between the two, just by the time youget them to the lab, you've

already pre-treated whattypically the broken heart syndrome theoretically hasdone, meaning the increased catacolamines, stress levels,given these people morphine so that takes away their wholeconcern about whatever they came in there for, for awhile. you've got beta blockers onboard, decrease the krfl atfl akrfl alawful -- catacalameandrive, you've given them aspirin, you've given themheparin probably. so you have taken away all thethings that they came in with

in the first place.so by the time you get them to the lab, and you try to take alook at those arteries, they have already relaxed,everything back to normal. but you may see a residualballooning entity we talked about earlier.that comes from a result typically of probably, and,again, this is all thee rhett al -- theoretical spasm in thevessel supplying that to the heart.because that area becomes stunned, the rest of the heartis trying to compensate for

the fact that that area is notworking well anymore. so it can get vigorous, therest of the heart, where that area is not, so it kind oflooks like a ballooning effect, because the rest ofthe heart squeezes while that area doesn't move very well.kind of looks like it balloons out>> that can cause general spasms.>> that can be as a result of that spafl.and then that -- spasm. at that can subsequently causesome of these other entities.

the key issue is you want toreduce the risk of sudden death.meaning, you know, what causes that -- what a lot of peopleget the term sudden death in heart attack confused.they will use them interchangeably, but they arereally not related. but sudden death can come as aresult of a heart attack. sudden death just means thatthe heart rhythm, it west to a heart rhythm that's notsustainable with life. i don't know if you've heardthe term ventricular tacky

card ya or fibrillaton.those are rhythms that oftentimes lead to suddendeath because the vent trickle or the bottom chamber of theheart can no longer pump ee if he can tiffly to --effectively to exclude blood or to get it out of the heart.so what happens, as a result of this kind of rhythmdisturbance, the heart ceases to function.it ceases to function, you can't live if it is notfuksing appropriately, because -- functioningappropriately, because no part

of the body is gettingadequately oxygenated blood. what happens, everything shutsdown. so if p you have a scenariowhere, say -- if you have a scenario where you cut offblood flow to the heart even temporarily, if you don't getthe right medicines on board fast enough, you can have aheart rhythm problem that can lead to a sudden death event.that's why we always recommend people getting to the hospitalas quickly as they can. oftentimes if you get a personthere quickly enough, you can

prevent or give medicationsthat will prevent that entity to happen that would lead tosudden death. >> so that we can let ourviewers know what those instances where they do needto get to the hospital right away, i would like to talkabout the symptoms and signs, but before we even get there,if we could address more generally cardiovasculardisease and risk factors for cardiovascular disease.>> all right. if you look at most of themajor risk factors, they are

actually pretty commonprocesses of things like hypertension or high bloodpressure. they are usedintercontainingably. -- interchangeably.i can go into that if you would like me to.diabetes. elevated cholesterol levels.people that smoke. those have a family history ofheart problems. and when i say family history,a lot of people don't understand that what deems afamily history is premature

heart disease, meaning mother,brother, father, sister, first degree relative, who has aheart attack or some coronary disease event at an age lessthan 55, that's what deems a family history.once you get past the 50s, 55, 60-year-old age range, anybodycan have a heart attack, the potential risk goes up justwhen the age-relate the phenomena alone.that doesn't deem family tris -- history, geneticpredisposition. that just means, say if yourbrother had a heart attack and

he was 65, well, he's gotrisks like anybody else to have a heart attack.that doesn't put you at higher risk because he did.not at that age. if he had it at 45, differentstory. that could mean that you havea genetic predisposition. >> understood.>> so those are the typically the major ones.you talk about some of the other ones.they recently just added obesity, or physicalinactivity, another risk.

so that is a problem we havein this country, because of technology, you know, ofcourse, everybody has their finger on the remote control,people no longer get up and do things.think about when we were kids, you know, you would gooutside, your mother sends you out.you came back when the streetlights came on.you knew that was the time to come back home.now -- >> i am much older than you.[ laughter ]

>> but i do remember that.>> yes. >> for me it was just, youknow. >> those are times when youthink about those who are very much active.>> indeed. >> those were active days.nowadays it's gotten to where kids are on video games, andthey are on ipads. i mean, ipads are fun, andthey are great, they are just unfortunate so they don'talways, you know, give you that type of activity thatkeeps you healthy.

so you will see a lot of --that's why i think the childhood obesity problem hasgotten so large now, because of that physical inactivity.you got kids now, they can't even do two pullups.you know, it is really a change in pace of what used tobe the case. >> perhaps one day someonewill invent a video game that demands interaction, you know,that also demands physical activity.>> yes. >> let's talk now about thosewarning signs that someone

need be aware of in terms ofcardiac event. >> well, if you look at mostof the classic signs, you know, chest discomfort, and iemphasize the term discomfort, because i've had patients whowould tell me that they don't feel pain, but they feelpressure or tightness or discomfort in the chest.characteristically mid-chest, it can radiate into the jaw,into the arm, it can radiate through to the back.some people have no radiation at all.shortness of breath.

all this is acute, meaning,you know, i don't want people to think that every time theyfeel the least little thing in their chest they need to runto the emergency room. people know when there'ssomething serious going on. it doesn't take much for themto figure out that they are having a major problem.the standard, you get a twing here, twinge there, thestandard is prolonged ongoing discomfort is what i'mreferring to. anything that lasts more than10 or 15 minutes may require

immediate attention.some people break out in a cold sweat.you know, they just start pouring sweat.some people will develop nausea.you know, a lot of people think it's just gas.you you know, i think what i usually tell patients to kindof help them in terms of trying to decipher should theycome to the emergency room, i always say whenever in doubt,just go. but one of the things that,you know, i tell people all

the time, if you are a personthat's 20 years old, what is the likely of a 20-year-oldhaving a heart attack. small.it is not impossible, it's just small.compared to a 65-year-old. but if you have other riskfactors, say, if you know you smoke, like a chimney, i mean,three-pack-a day smoker, high blood pressure, never beencontrolled, you are diabetic, you have a cholesterol that's300, you know, and your father died of a heart attack at age32, and you start having chest

pains, to me, there is noquestion that you need to be checked out immediately.now, versus, again, a 20-year-old with no othermedical problems, the likelihood is less.i mean, again, when in doubt, just go and be checked out.>> we only have two and a half, three minutes left here.tell me about the state health elevation conference.>> one of the things we are doing with the james newby,jr. foundation, my father -- >> i remember your dad well.>> you sure you are old

enough?>> i keep telling you, man. my father used to go to yourdad. >> okay.>> i remember your dad very well.i liked him a lot. >> thank you.he was an internist in the area, he died young at age 41.he had a heart tumor. i created a foundation in hisname to foster some of these clinical activities that wewant to do, because educating the community, trying to getpeople to understand what

needs to be done in order tolive healthy. we want to be able to fosterthat. so this state health elevationconference is a one-day conference, march 2nd, andthis year, at 7:45 a.m. to 4:30 p.m. on saturday, march2nd, norfolk state university, student union building.i have a lot of my doctor colleagues together, we aredoing -- all volunteering our time to do this.reached out to business people, to finance people, andsome of my church members to

put on different lectures ondifferent topics. >> how can someone find -->> you can call our offices, 757-624-1785, and we also haveonline registration, you can see the program, everything,www.vahealthconference.com. and that will give you all theinformation you can register online, you can pick whateverlectures you may like to hear about.and we're really touching on multiple topics.not just pure health, but finance.>> that's the web address i

didn't have.>> www.vahealthconference.com. we just got that recently,because we wanted to have the online registration.>> understood. >> my facebook page also has anoted area. >> we do have that facebookpage. >> we are hitting it from allangles. we will be doing some otherthings as well. >> any way that i can help,let me know. >> you can show up.>> absolutely.

>> thank you so much forcoming onto the show. >> you are quite welcome.>> good to have you back on. we need to do this again.>> i look forward to it. don't be a stranger.calling me back. >> absolutely not.you know, african-american men, it is important also.>> which i have participated with.i saw your email go out about that.i figured i would be getting a call about that from yousooner or later.

look forward to it.>> thank you so much. >> anytime.>> nice seeing you. >> we want to thank you forjoining us for this edition of healthwatch.remember, you can watch previous editions ofhealthwatch online, www.for noek.gov -- www.norfolk.com,or drop me a line at terrance.afer-anderson@vdh.virginia.gov. feel free to give me a call757-683-8836. for the norfolk department ofpublic health, i'm terrance

afer-anderson.this has been healthwatch. captioning provided bycaption associates, llc captionassociates.com\m\m