These days I am reading an inspiring book, “Don’t Sweat the Small Stuff…” by Richard Carlson, gifted by a gentile couple Cora and Allan Abreo, my friends since long. Like psychologists they gauge my level of “distress” and gift me the right book to “de-stress”. I would not hesitate to recommend it to anyone who would want to live a more calm and peaceable life. The stirring book contains a number of short inspiring chapters written in simple, easy style. In the chapter titled “Practice Humility”, Carlson writes, “Humility and peace go hand in hand. The less you try to prove yourself to others, the easier it is to feel peace inside”. Further, he affirms, “Making efforts to prove yourself is a dangerous trap since it takes an enormous amount of energy bragging about your accomplishments or trying to convince others of your worth as human being”. Truly, as we constantly try to prove our superiority vis-à-vis others we get engulfed into the rat race and unwittingly get caught up in a fiercely competitive struggle for wealth, power and fame. And this generates a lot of emotional stress. We often hear people say, “No wonder he died! With all the stress he was in he finally got that heart attack!”
Medical researchers aren’t sure how exactly stress increases the risk of heart disease. It is possible that stress itself might be a risk factor for heart attacks, or it could be that high levels of stress make other risk factors (such as high cholesterol or high blood pressure) worse. For example, if you are under stress, your blood pressure goes up, you may overeat, you may exercise less and you may be more likely to smoke. Chronic stress also exposes your body to unhealthy, persistently elevated levels of stress hormones. Significantly, studies also link stress to changes in the way blood clots, which further increases the risk of a heart attack.
But few would know that besides triggering heart attacks there’s a novel way in which stress assails our hearts. You probably hadn’t heard about it, so please read on. A 71 year-old woman was giving the eulogy at her best friend’s funeral. Under intense emotion, as she delivered her speech, she developed severe chest pain and collapsed. She was immediately rushed to a tertiary-care hospital. Upon arrival here, her blood-pressure was very low, her heart rate was fast, and there was profuse sweating. Her ECG demonstrated what is called “ST-segment elevation” and the ECHO revealed decreased pumping function of the left ventricle. The provisional diagnosis? Massive heart attack. Shifted to the catheteterization room, an immediate “coronary angiogram” revealed “normal coronary arteries” ruling out the diagnosis of heart attack. When the dye was further injected into the cavity of the left ventricle (left ventriculogram), its tip had “ballooned out”. What was the lady suffering from? Could anyone guess? Was it a heart attack? The answer is no. She was affected by a rare condition called “Takotsubo Cardiomyopathy”.
Though I have not diagnosed any such case in my clinical practice in Goa, when I recently went to the Johns Hopkins Hospital, in Baltimore, USA, as a Visiting Professor, I had an opportunity to see a few such cases. Now, with an increased awareness of the problem, I expect to clinch some diagnoses here in Goa. To tell the truth, it is a matter of huge relief when you come across a case which closely mimics a heart attack but turns out to be a Takotsubo because it has a benign outcome. It should be suspected in postmenopausal women with acute heart attack symptoms following an emotionally stressful event. The treatment is supportive and the best thing is that within a week or so all heart abnormalities return to normal.
Takotsubo is a type of cardiac enlargement in which coronary blockages are luckily absent. Triggered by emotional stress it is also known as “broken-heart syndrome”. The hallmark bulging out of the “apex” of the heart with preserved function of the “base” earned the condition its name “tako tsubo”, or “octopus pot” and was first described in Japan. It is triggered by an outpouring of stress hormones and is benign in nature.
In the coming years, scientists may discover yet other rare cardiac affections triggered by stress. Stress takes a heavy toll on humans. To those who live life in the fast lane here is an illustrative example of what stress can do: Karl, 64, was a self-described “type-A personality.” His typical day would consist of eight or more hours on the job. On top of this it was a 24 x 7 “manic schedule” of bringing up four children. He was a habitué at films, concerts, parties and fond of frequent travel. “My approach to everything is to start at 100% and go up from there,” he would say… But after a heart attack and triple bypass surgery he was sadly forced to slow down since now his life depended on new and wiser choices.
As far as stress is concerned, therefore, it is sensible to feel safe rather than sorry! Before it mows us down we must try our best to nip all stressors in the bud – sooner rather than later.
(Dr. Francisco Colaço is a
seniormost consulting
physician, pioneer of
Echocardiography in Goa.)
