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Patient Care

Stress Cardiomyopathy Rates Double During Pandemic

Akron Beacon Journal

For a growing number of people, stress from the coronavirus pandemic is heartbreaking.

A new Cleveland Clinic study led by an Akron General cardiologist discovered an increase in "broken heart syndrome," or stress cardiomyopathy, during the COVID-19 pandemic.

The number of cases doubled compared to before the pandemic.

The study, conducted March 1 through April 30, appears today in the medical journal JAMA Network Open.

Stress cardiomyopathy occurs in response to physical or emotional distress and causes dysfunction or failure in the heart muscle.

"It's been associated with severe emotional stress, but it could be any type of stress like breakups, loss of a loved one, a heated altercation with a family member or severe depression," said Dr. Ankur Kalra, an Akron General cardiologist who led the study.

Patients experience the same symptoms as a heart attack, including chest pain and shortness of breath, but usually do not have acutely blocked coronary arteries, Kalra said. In some cases, it can be fatal.

The left ventricle of the heart may show enlargement. Other symptoms include irregular heartbeat, fainting and low blood pressure.

The causes of the condition, also known as Takotsubo cardiomyopathy, are not fully understood. Doctors believe a person's reaction to stressful events causes a release of stress hormones that temporarily reduce the heart's ability to pump – causing it to contract less efficiently or irregularly.

Kalra and his colleagues started to notice an uptick in cases in late March.

"Is this the virus causing this or is it the stress from the virus causing this?" he wondered.

For the study, cardiologists at the Cleveland and downtown Akron campuses looked at 258 patients coming in with heart symptoms known as acute coronary syndrome and compared them with four control groups before the pandemic.

The number of broken heart syndrome cases doubled in March and April from pre-pandemic levels.

Patients during the pandemic had a longer hospital stay compared with those before the pandemic, but there was no significant difference in death. All tested negative for COVID-19.

The number of cases could have been higher as ERs saw a "precipitous drop" in patients during the height of the pandemic, when people were staying away from the hospitals, Kalra said.

Typically, 90% of patients with broken heart syndrome are women over the age of 70. In the study, 30% were men and the median age of all patients was 63.

The condition is usually treated with heart medications and possibly stress medication.

But a key to prevention and treatment is reducing stress and practicing self-care, Kalra said.

That is particularly important as the pandemic continues to evolve, said Dr. Grant Reed, director of Cleveland Clinic's STEMI (ST-elevation myocardial infarction) program and senior author for the study. "Exercise, meditation and connecting with family and friends, while maintaining physical distance and safety measures, can also help relieve anxiety."

Richard Watkins, 64, of Tallmadge knew his life was stressful, but he didn't expect the stress to nearly kill him.

He has gastroesophageal reflux disease (GERD), a condition where acid from the stomach comes up into the esophagus, but no previous heart issues.

But in the weeks leading up to his April 15 health crisis, the pandemic shut down production at General Aluminum Manufacturing Company in Rootstown, where Watkins is chief financial officer. The auto parts manufacturer laid off 600 employees in several states. Watkins and his wife, Nichol, struggled to help their sons, age 12 and 10, with online schoolwork.

Watkins' 2-year-old grandson was in and out of the hospital with Guillain-Barré syndrome, a sudden temporary disorder that took away his ability to walk.

Watkins' 91-year-old father also died after a fall at his home.

"We were getting ready and getting dressed to go to the funeral and that morning I came out to breakfast and I remember parts of it, but I was acting oddly, as my wife would put it," said Watkins. "I had on a white dress shirt buttoned up to the collar, socks and underwear, but I forgot my pants. She said, 'What are you doing?'

He said he felt weird and the back of his arms felt funny. He thought it might be his GERD. He only remembers putting his head down on the table.

His wife called 911 and was instructed by dispatchers to perform CPR. Once crews arrived, they had to shock Watkins' heart to get a pulse.

Initially, Nichol was told Watkins had a massive heart attack, but later was informed that his arteries weren't blocked.

The diagnosis: broken heart syndrome.

"I'm thinking, 'My husband just stopped breathing, I just did CPR on him, the paramedics had to get a pulse on him and he's going to be fine?"

Watkins was placed into an induced coma with a ventilator and did not regain consciousness for five days.

Watkins took six weeks off work and has been working on reducing his stress levels.

"I hope people realize, listen to your body. If your body is tingling, if you're having chest pains.. you've got to take care of yourself," his wife said. "You need to do what's best for yourself and your family."

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