Stress cardiomyopathy is a serious condition involving injury to the heart muscle resulting from acute stress. It is a type of heart failure that can lead to serious complications such as irregular heart rhythms and blood clots.

Stress cardiomyopathy is also known as broken heart syndrome and Takotsubo syndrome because the left ventricle changes shape, resembling a Japanese ceramic vase (Takotsubo). This article aims to examine this condition with an emphasis on root causes and prevention. 

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What is Stress Cardiomyopathy?

Stress cardiomyopathy is left ventricular dysfunction after an extremely stressful event, often occurring one to five days before the symptoms start. The left ventricular wall changes shape due to stress on the myocardium (heart muscle). The exact causes are complex and not fully understood, but there appears to be a relationship to the brain because of its occurrence with traumatic events.

The cardiovascular effects appear to be related to increased norepinephrine and neuropeptide Y release after acute trauma. Another theory is the sudden influx of catecholamines and stress hormones after an acutely stressful situation. The stressful events leading to this condition may be strong emotions, natural disasters, surgery, traumatic events, intoxication, and withdrawal from drugs. One possible stressor is the death of a loved one, resulting in the term “broken heart syndrome”. However, stress cardiomyopathy is not always preceded by an extraordinarily stressful event. 

The incidence of stress cardiomyopathy in the United States is about 15 to 30 cases per 100,000 people. The most likely population to develop this condition is postmenopausal women. Many women with reported cases have underlying levels of stress and anxiety before the causal event. Diabetes mellitus is also a risk factor and is associated with a higher risk of death from cardiovascular injury. Stress cardiomyopathy may also occur after a severe asthma attack, especially attacks treated with rescue inhalers. Patients who use cannabis and have stress cardiomyopathy are more likely to experience cardiac arrest (three times higher risk). 

Clinical manifestations of stress cardiomyopathy include chest pain and shortness of breath. These symptoms are the most common and may occur with dizziness and syncope. On examination, the patient typically has a high heart rate, low blood pressure, cool skin, an arrhythmia (S3 gallop), distention of neck veins, and abnormal lung sounds (crackles/rales). Stress cardiomyopathy differs from a myocardial infarction (heart attack) in that during a cardiac catheterization there is no evidence of a plaque or blood clot obstructing a coronary artery.

A Root Cause Medicine Approach to Heart Health

Root cause medicine using a functional approach aims to prevent health conditions before they occur. This approach also views health conditions as multifactorial rather than focusing on a single cause. Root cause medicine aims to holistically treat the patient and discover the underlying cause of disease while supporting mental, emotional, and physical wellness.

This perspective also addresses the many factors that can lead to a cardiovascular condition like stress cardiomyopathy. Practitioners in this specialty address the genetic, lifestyle, and environmental factors that can predispose a patient to illness. Root cause medicine addresses these background factors, while also integrating functional medicine with conventional treatments. Treatment for health conditions, including cardiovascular care, is personalized to the patient and their unique history and lifestyle. 

The Role of Stress in Stress Cardiomyopathy

Individuals with underlying mental health conditions, such as anxiety or increased stress, appear to be more at risk for cardiomyopathy. The classic presentation of stress cardiomyopathy is a postmenopausal women, and this may be due to the increased risk of depression in this population. Women in this stage of life may also have increased stress from other health conditions, increased social isolation, and transitions in their personal lives (e.g. children leaving home). Stress takes a toll on the body and can cause physical symptoms, especially for women. Chronic stress and acute stress lead to increased catecholamine release, putting the patient at risk for cardiac conditions such as cardiomyopathy.

Not all individuals who undergo stressful or traumatic events develop cardiomyopathy, and this may be due to established social support or enhanced ability to cope with stress. The acutely stressful events that contribute to cardiomyopathy cannot always be avoided (e.g. natural disasters), but reducing underlying stress and addressing mental health challenges can help prevent myocardial damage and heart failure if traumatic events do occur. 

Root Cause Medicine Strategies for Prevention and Management

Because underlying stress can increase the risk for cardiomyopathy, reducing daily stress is an important aspect of prevention. Stress reduction techniques such as yoga can reduce cortisol and help regulate the nervous system. Yoga promotes a restful and balanced state by modulating the parasympathetic nervous system. Meditation is a mindfulness practice that uses different techniques and intentional breathing to help calm the nervous system. Individuals who practice yoga and meditation report reduced daily stress and improved responses to stressful events. Balanced nutrition can help the body fight free radicals and prevent oxidative stress. Adequate vitamins through whole foods and supplements like glutathione can help the body find balance during hectic life circumstances. 

Existing dysfunction of the endothelium, the inner lining of the arteries, can predispose a patient to cardiovascular events such as heart attacks and cardiomyopathy. Nutrition plays a vital role in keeping the arteries and heart healthy. A diet rich in plant-based foods such as fruits, vegetables, beans, nuts, grains, and seeds can support the function of every body system, including the heart. Monosaturated fats can also play a role in promoting heart health, and these can be found in olive oil, nuts, and avocado. These foods are rich in omega-3 fatty acids that can help promote a balanced ratio between omega-3 and omega-6 fatty acids.

Fast food and processed food should be avoided because these choices promote inflammation and contain high levels of saturated fats, sugar, and salt. Alcohol should generally be avoided due to health risks and minimal benefits. Processed meats (e.g. hot dogs), processed grains (e.g. white bread), and foods with added sugar should be limited to promote heart health. These dietary guidelines can help keep the endothelium healthy and prevent cardiovascular disease and heart failure. These lifestyle changes can also promote balanced blood sugar levels and assist in treating diabetes mellitus, a risk factor for stress cardiomyopathy. 

Additional lifestyle factors that promote cardiovascular health include sleep, physical exercise, and social support. Getting adequate sleep can promote a healthy microbiome, reduce inflammation, and reduce stress. Adequate sleep reduces anxiety and depression and can promote resilience to stress, an important aspect of preventing cardiomyopathy. Most adults need seven hours or more of sleep per night, and over 33% of adults do not meet this requirement. This amount of rest allows the body to undergo the necessary stages of sleep and promotes restorative sleep. Exercise provides the body with many benefits, including inflammation reduction and better cardiac health.

The systemic benefits of movement may be extra beneficial for individuals with anxiety and depression. Recent research has shown that exercise helps counteract stress by activating specific neural networks. Patients with anxiety and depression had “more than double the benefit from exercise in terms of reduced cardiovascular risk”. Patients with reduced social support are more likely to experience higher stress levels and are more at risk for cardiac diagnoses such as cardiomyopathy. Social isolation and a reduced support system can increase the likelihood of cardiovascular disease by as much as 42%.

Social isolation can take many forms, but it often involves limited contact with friends and relatives, decreased community involvement, and a very small social network. The risks of reduced social contact and increased incidence of cardiovascular disease and stroke are particularly apparent in older adults.  

Healthcare providers should provide guidance and education about cannabis use and its risks. The use of marijuana puts the patient at risk for stress cardiomyopathy and cardiac arrest. 

Some supplements can provide additional cardiovascular benefits when combined with lifestyle changes. There is some evidence that vitamin D supplementation may decrease the incidence of coronary artery disease, and many Americans are deficient in this vitamin, especially at higher latitudes. Low levels of vitamin D may be associated with insulin resistance, high blood pressure, and high cholesterol. However, the link between this deficiency and the development of heart disease is not completely understood.

‍CoQ10 (ubiquinone) is involved in energy production and may improve the health of the endothelium. Low levels of CoQ10 were noted in patients with cardiomyopathy, suggesting that supplementing with this molecule may be beneficial. The potential benefits of CoQ10 for heart disease are still being established, and supplementation should be initiated under the guidance of a healthcare professional. Supplementation with Omega-3 fatty acids, specifically EPA and DHA, may improve lipid profiles. Omega-3 prescriptions are sometimes used to treat high levels of triglycerides, a risk factor for cardiovascular disease. These molecules can help reduce inflammation and should be implemented with other heart-healthy lifestyle changes. 

Adaptogenic herbs can help patients manage stress, a risk factor for cardiomyopathy. Ashwagandha and Rhodiola are two herbs that can help balance cortisol levels and support a balanced sympathetic nervous system.

Investigating Underlying Causes

Holistic medical care involves treating the patient as a whole person, including investigating the root causes of disease. Using this approach to treat the causes of underlying mental health conditions can help prevent stress cardiomyopathy. 

Using therapeutic techniques such as cognitive behavioral therapy can address the root causes of stress. Eye Movement and Desensitization and Reprocessing (EMDR) therapy can help the patient work through past traumatic events. Identifying and working through contributing factors to anxiety and depression can improve the patient’s overall well-being and reduce their risk for cardiovascular conditions. 

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Key Takeaways

Stress cardiomyopathy is a serious form of heart failure that is typically reversible, but can cause several complications. Though it is often caused by an acutely stressful event, the patient’s overall cardiac risk profile and baseline mental health affect the severity and outcome of the condition. Preventing cardiac risk factors and implementing heart-healthy lifestyle behaviors can reduce the risk of cardiomyopathy and other adverse cardiac events.

Promoting the health of the heart and blood vessels can reduce the risk of developing heart failure. Any individuals experiencing chest pain, shortness of breath, dizziness, and fatigue should seek medical evaluation to rule out cardiac pathologies such as cardiomyopathy and heart disease. 

Addressing mental health conditions such as underlying stress, anxiety, and depression can help prevent adverse cardiac effects if a traumatic event does occur. Patients experiencing high levels of stress should seek treatment for the root cause to prevent cardiovascular conditions and promote their overall well-being. Enhanced social support and improved coping skills can be protective against cardiomyopathy. Prevention and personalized care aims to prevent conditions such as stress cardiomyopathy and reduce complications.