ADVERTISEMENT

• JOBS
• CE
• Cardiopulmonary
• Geriatrics &
  Home Health
• Neurology
• Pediatrics
• Sports & Orthopedics
• PT Toolbox
• HOME

Search Over 1026 PT Jobs

State All States Alaska Alabama Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

Specialty All Specialties Physical Therapy Physical Therapy Assistant Physical Therapy Manager

Keywords

• Print This
• Select Text Size:
• Comments
• 

Folklore is full of stories in which people died of fright or a broken heart, but the healthcare community has recently found a name for this phenomenon: stress cardiomyopathy. The good news is that even though the symptoms may mimic those of a heart attack, the patient’s blood flow is not actually blocked and in most cases there are no long-lasting cardiac effects after the experience.

Also referred to as “broken heart syndrome,” the condition is increasingly getting the attention of researchers and doctors, and it can show up in the practices of physical therapists.

Pure Adrenaline

Although mostly occurring in elderly women who experience emotional stress over news such as a death in the family or a car accident, SC also can occur in athletes during intense physical exertion such as extreme sporting events, says Larry Cahalin, MS, PT, CCS, a senior clinical professor at Northeastern University in Boston.

“It’s not completely or fully understood, but stress cardiomyopathy can occur at times of severe emotional or physical distress,” he says.

Cahalin says he observed the condition once in a female athlete competing in an ultramarathon cycling event called the “Race Across America.” He was studying the effects of ultramarathon cycling in the last leg of the grueling event, which required cyclists to ride from the West to East Coast in seven to 10 days, cycling as many as 23 hours each day.

“We were doing blood tests and cardiovascular tests on the athletes when one of the athletes started to demonstrate signs of heart failure,” Cahalin says. “She had swelling in her ankles and legs, substantial shortness of breath, and other signs of heart failure.”

Cahalin recommended she stop riding and go to the emergency room. Once there, the medical staff removed some fluid surrounding her heart and lungs and in her legs, but she refused to withdraw from the race, continuing on at a slower pace to the end of the race where she won the women’s division.

Stress Attack

Stress cardiomyopathy, also called apical ballooning syndrome, has been the topic of several recent studies. First recognized by Japanese physicians, SC has been reported to account for 1% of admissions for suspected acute myocardial infarction in Japan during the past decade, according to G. William Dec, MD, chief of the cardiology division at Massachusetts General Hospital. More recently, the syndrome has been reported among the white population in the United States and Europe.

Dec explains that all patients entering the ER with symptoms of myocardial infarction will be treated the same, and it is only after angiograms and other testing to eliminate the diagnosis of an MI that SC is identified.

“A patient with a major life stressor is as likely to have an MI as this,” he says. “Less than one-tenth of 1% of all the people we see have apical ballooning syndrome.” The central cause of this syndrome is probably related to
adrenaline, Dec says.

In a recent study published in The New England Journal of Medicine by physicians at Johns Hopkins University, 18 female patients and one male patient who were admitted to the hospital with chest pains or symptomatic heart failure after a sudden stress were examined. Emotional stressors leading to the cardiac symptoms included car accidents, armed robbery, death of a family member, surprise parties, and public speaking events. The study concluded that emotional stress can cause severe, but reversible, left ventricular dysfunction in patients who do not have coronary disease.

“In terms of recognition, SC is definitely something PTs should be aware of, especially [in] patients undergoing an extreme amount of emotional or physical stress,” Cahalin says.

In addition to leg swelling and shortness of breath, PTs should watch for other symptoms of SC, such as profound fatigue, abnormal breathing and lung sounds such as rales (crackling sounds heard during inspiration), and a third heart sound, he says.

“If the PT finds these symptoms in a patient, they should refer him or her to the ER or a primary care physician,” Cahalin says.

Patients who have experienced SC have similar rehabilitation needs to those recovering from other cardiac complaints. “They need formal exercise, rehabilitation,
monitoring, and reassurance just like a patient recovering from a bypass or angioplasty,” Dec says. “They had an event and are often shaken up. They need someone to push them into thinking they [can] do what they could before.”

PTs also should be aware that patients who have experienced SC have a 5 to 8% chance of the condition recurring, Dec says. For that reason, physicians typically keep patients who have experienced SC on beta-blocker medication.

In the event of shocking news or extreme physical stress, PTs might be able to fend off SC in their patients by suggesting therapies such as deep breathing, meditation,
and yoga, Cahalin recommends. Biofeedback devices that measure a patient’s breath can be used to show ways patients can change breathing patterns and reduce stress.

PTs also can advise patients undergoing extreme stress to seek a consultation with a physician for further help in dealing with their stress. “Such interventions could possibly help [protect] the patient from ever developing stress cardiomyopathy,” Cahalin says.

---

Teresa McUsic is a medical writer for the Gannett Healthcare Group.
To comment, e-mail pteditor@gannetthg.com.

© Copyright 2009 Gannett Healthcare Group