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Broken Heart Syndrome (transcript)
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Child’s Voice:  There once was a time when we were truly free, free of worry, free of fear, far from doubt. That is strength. That is power. That is fearless.

Narrator: "Second Opinion" is funded by Blue Cross Blue Shield, which is committed to improving healthcare accessibility and supporting more affordable community clinics where care is limited. Blue Cross Blue Shield,  "Live fearless."

Narrator: "Second Opinion" is produced in association with the University of Rochester Medical

(PETER SALGO) This is "Second Opinion"and I'm your host. Today, we're joined by special guest, MaryAnn Murray. She is living proof that stress can have serious health consequences. You won't want to miss her story.

(MARYANN MURRAY)  It was Father's Day weekend, and I had a family picnic planned. And I was keeping everything inside, and then all of a sudden, I just lost it and hollering at everybody and crying.

(PETER SALGO) Okay.

(MARYANN MURRAY) But then, as I did it, I could feel that I was having pressure. I knew something was wrong with having pressure.

(PETER SALGO) Thanks so much for being here, MaryAnn. I know that you've got a lot to tell us, a great story, so we're gonna get right to work. And what I'd like to do first is introduce you to your "Second Opinion" panelists. And they're gonna be hearing your story for the first time. They are Dr. Ilan Wittstein from Johns Hopkins University School of Medicine, Dr. Sam Sears from East Carolina University, and "Second Opinion" primary care physician from the University of Rochester Medical Center, Dr. Lou Papa. All right. MaryAnn, two years ago, you had a house full of guests. You had company staying with you, I understand. And you were under a lot of stress. Why don't you tell me about that?

(MARYANN MURRAY) Well, um, it was... Family was there. It was Father's Day weekend, and I had a family picnic planned for on the Sunday.

(PETER SALGO) No pressure here.

(MARYANN MURRAY) No. And I was keeping everything inside. And then all of a sudden, I just lost it.

(PETER SALGO) What do you mean by "lost it"?

(MARYANN MURRAY) Well, I just started hollering at everybody and crying.

(PETER SALGO) Okay.

(MARYANN MURRAY) But then, as I did it, I could feel that I was having pressure. I knew something was wrong. I was having pressure. And I couldn't breathe. As I started talking, it was hard to get it out, you know?

(PETER SALGO) When you said pressure, you did this.

(MARYANN MURRAY) Yeah.

(PETER SALGO) So chest pressure.

(MARYANN MURRAY) Yes, yes.

(PETER SALGO) Okay, now where I was taught, somebody doing this or this or this, that's heart. Chest pressure is not a good thing.

(MARYANN MURRAY)  Right.

(PETER SALGO) What did you do?

(MARYANN MURRAY) I knew something was wrong, but I just kept quiet and didn't tell anybody. Everybody gets --

(PETER SALGO) Not a recommended procedure, I'd like to point out.

(MARYANN MURRAY) No, it isn't. And everybody got settled down, and I tried to go to bed, but I couldn't sleep. I couldn't lay down. So I got up and sat in the chair for the night and kind of dozed off. But I kept myself alert 'cause I knew something was wrong.

(PETER SALGO) You were sleeping in the chair?

(MARYANN MURRAY)  Yeah.

(PETER SALGO) That's not what you normally do, right?

(MARYANN MURRAY) No, no, no.

(PETER SALGO)  So something was really wrong.

(MARYANN MURRAY) Right.

(PETER SALGO) Were there any other stressors in your life?

(MARYANN MURRAY) Just the usual, you know.

(PETER SALGO) Okay.

(MARYANN MURRAY) Being a mother of a big family.

(PETER SALGO) No stress being a mom, right? And you didn't call the doctor. But what finally happened? What -- what -- what changed?

(MARYANN MURRAY) Well, when I got out of the chair, I felt better, so I thought, "Okay, that really wasn't anything." And then, as the next day came, I didn't feel so good. So then I decided to go to the doctor. They did an EKG.

(PETER SALGO) Okay.

(MARYANN MURRAY) And I found out that -- He said I needed an echo, and so I made an appointment.

(PETER SALGO) So, wait. Let me stop for a second. You go to see your doctor. You say, "I've got chest pressure."

(MARYANN MURRAY) Right.

(PETER SALGO) And your doctor gets a -- get an electrocardiogram, which is just a picture of the electricity going through your heart 'cause your heart runs on electricity. And then your doctor says, "Whoa. Time for an echocardiogram," which is a picture of your heart. So far, other than the fact she waited a day, you guys have any comment on this, Lou?

(DR. LOU PAPA) I'm a little bit concerned. If she had those kind of symptoms throughout the night and she couldn't lie flat, I'm not sure I'd feel comfortable just getting an echo right there and then. You know, the big concern is if you're having a cardiac event or a heart attack.

(PETER SALGO) Well, you just said the magic words, right? Everybody here, I think -- Are we all worried you're having a heart attack?

(DR. LOU PAPA) Right.

(PETER SALGO) Were you worried about that?

(MARYANN MURRAY) A little bit in the back of my head, but I kind of just pushed it away.

(PETER SALGO) Okay.

(MARYANN MURRAY) Because I had a picnic that was scheduled for Sunday, and I had to get everything ready, you know.

(PETER SALGO) You are such a mom.

(MARYANN MURRAY) Yeah. So, anyway -- And I didn't feel that bad. But I scheduled the echo for Monday.

(PETER SALGO) Okay, so he didn't do the echo, or you didn't do the echo, that day?

(MARYANN MURRAY) No.

(PETER SALGO) You put it off.

(MARYANN MURRAY) Right.

(PETER SALGO) Look at Lou.

(DR. LOU PAPA) Yeah, I mean, the big concern about that is, you know, time is muscle. So if you're having a heart attack, the longer you wait, the more damage that's done to the heart, and it could be life-threatening. I would've sent you to the emergency room is what I would've done. You need an expert. You need people that are gonna intervene right away to find that it is or it isn't cardiac issues and, if it is, to intervene and minimize what damage has been done. You know, putting off the echocardiogram is allowing more damage to be done.

(DR. SAM SEARS)You know, it's funny. You said "Minimize the damage." She was minimizing the presentation because she had so much to do.

(DR. LOU PAPA) But that's classic, right? It's a very classic thing.

(PETER SALGO) "If I don't go to the doctor, I'm not sick."

ALL:  Right.

(DR. ILAN WITTSTEIN) Not only was she having chest discomfort, but she was sitting up at night, which is usually a sign that there's fluid in your lungs, and we call that congestive heart failure.

(PETER SALGO) Heart failure. Not just that your heart is sick and it's giving you pain, but it's failing. And fluid is building up in your lungs. That can't be good.

(MARYANN MURRAY) They had it for the next morning, and I said, "I can't do that." And then I scheduled it later because I didn't realize it was an emergency.

(PETER SALGO) Just for the record, you are not the poster girl for what to do with a heart attack.

(PETER SALGO) That being said, you --

(MARYANN MURRAY) Now, if my husband was having one, I would've known what to do.

(PETER SALGO) Yeah, 'cause you're the mom. And you're that -- You're the caregiver here, and you feel everything inside 'cause you know what to do for everyone else. That's the stress, right?

(MARYANN MURRAY) Right.

(PETER SALGO) Okay, so finally, everything else done...

(MARYANN MURRAY)  Mm-hmm.

(PETER SALGO) You went to get your studies. And what happened?

(MARYANN MURRAY) Well, they admitted me to the hospital.

(PETER SALGO) They admitted you to the hospital.

(MARYANN MURRAY) And then I had to go have -- to see if there was any blockages in my arteries.

(PETER SALGO) So their thinking was chest pain, shortness of breath, sitting up in a chair -- could be a heart attack.

(MARYANN MURRAY) Right.

(PETER SALGO)  So you went to the cath lab to look for blockages?

(MARYANN MURRAY) Yes, mm-hmm.

(PETER SALGO) And what did they find?

(MARYANN MURRAY) None. I had no blockages.

(PETER SALGO) No blockages.

(MARYANN MURRAY) Right.

(PETER SALGO) So no heart attack. And yet -- and yet – chest pain, shortness of breath, sitting up.

What did they say you had?

(MARYANN MURRAY) They called it a heart attack. I mean, that I had was called the broken heart syndrome. Maybe that's what it is.

(PETER SALGO) Okay, now there's a phrase for you -- broken heart syndrome. Just so happens, sitting to my right, is the son of a gun whose paper has been quoted for broken heart syndrome for several years now. Ilan, tell us, what is broken heart syndrome?

(DR. ILAN WITTSTEIN) Well, broken heart syndrome is really a fascinating condition, and usually, people go in exactly like you did, with chest pain, shortness of breath. And I have to tell you, when I started seeing this, we all called it heart attack, also.

(MARYANN MURRAY) Yes.

(DR. ILAN WITTSTEIN) But in a heart attack, there's a blockage inside an artery that prevents blood from getting to the heart. But what we found in people with broken heart syndrome is that there were no blockages. So it was very hard to call this a heart attack, in the conventional sense, when we weren't seeing any of those blockages. What we've found over the years is that this is a condition not where there's a blockage in the artery but where the heart muscle itself suddenly weakens. And you were having symptoms of that when you weren't able to lie down and when you were short of breath. And the reasons for that we can discuss, but the heart, after emotional stress – sometimes physical stress but often after emotional stress – suddenly weakens and causes a lot of the same symptoms that occur when you have a heart attack.

(PETER SALGO) Now, I remember reading your paper.

(DR. ILAN WITTSTEIN) Yeah.

(PETER SALGO) And the essence was stress, emotional distress, can lead to heart disease. Now, Sam, what do you think of all that? I gather you were not a skeptic.

(DR. SAM SEARS) No, I wasn't. And what's interesting about it is that today's technology allows us to document what philosophers and poets have been writing about for centuries, that emotional stimuli can cause the heart to act irregular.

(PETER SALGO) In other words, it failed. It failed. You had all the symptoms of a heart attack but didn't have a heart attack. You had this broken heart syndrome. And the prognosis for somebody with a heart attack versus broken heart is different.

(DR. ILAN WITTSTEIN) It is different. You know, it can be very dangerous to have broken heart syndrome. The heart muscle, it's responsible for pumping all the blood to the rest of your vita lorgans. And we know that when someone comes in with broken heart syndrome, the heart is not working right. It's not pumping properly. People can be incredibly sick. But what distinguishes it so readily from a heart attack is that the heart muscle, it's not dead tissue like it is with a heart attack. We use the term "stunned." It's as if the heart cells don't know what to do for a couple of days. And when you look at the heart, it looks terrible.

(PETER SALGO) With that, we're gonna take

a short break. Everybody stay right where you are. But first, we're gonna take care of this week's "Myth or Medicine."

NARRATOR: Broken heart syndrome may sound like a romantic expression, but it is an actual medical term. The exact cause of broken heart syndrome isn't entirely known, but the condition often occurs after a severely emotional or stressful event. Is there a link? Does stress cause broken heart syndrome? Is this myth or medicine?

DR. HIMA VIDULA:  Broken heart syndrome is caused by stress. That is medicine. And I'm going to tell you why. I'm Dr. Hima Vidula. I'm an assistant professor in the Division of Cardiology at the University of Rochester Medical Center. Researchers hypothesize that an increase in stress hormones, like adrenaline, can cause changes in the left ventricle, the heart's main pumping chamber, leading to heart failure and the broken heart syndrome. Patients with broken heart syndrome will present very similarly to patients who are having an acute heart attack. In fact, 5% of women who present for evaluation for a heart attack are actually found to later have broken heart syndrome. Luckily, patients with broken heart syndrome will have almost complete recovery of heart function within one to two months without any evidence of permanent heart dysfunction. And that's medicine.

NARRATOR:  Not sure if it's myth or medicine? Connect with us online. We'll get to work and get you a second opinion.

(PETER SALGO) And we're back with MaryAnn. Thank you for staying us across the break. You were in the hospital. You had all these symptoms that I was taught were the symptoms of a heart attack, but they said, after they looked at your heart in the cath lab, "No, no, no. No blockages in your arteries. Broken heart syndrome." Now, you wrote the paper. I'm putting you on the spot. What the heck is that, and how does it differ from a heart attack?

(DR. ILAN WITTSTEIN) So broken heart syndrome is a condition where the heart muscle itself suddenly weakens, usually after some kind of emotional or physical stressor. It can be sudden grief, like the death of a loved one. It can be just a lot of stress that builds up. It can be surprise. But the heart muscle doesn't react well to this sudden Stress. It suddenly weakens. And now you have a pump that's not pumping.

(PETER SALGO) That's bad.

(DR. ILAN WITTSTEIN) That's bad. It can lead to a lot of the symptoms that you described -- chest pain, shortness of breath, inability to lie down because there's fluid in your lungs.

(PETER SALGO) But, you know, throughout literature in human history, it's always, you know, horrible tragedy, and he died because his heart broke, died of a broken heart. This is sort of what we're hearing, isn't it, Sam?

(DR. SAM SEARS) It is, and I think this is, again, what's so interesting about it. In this day of medical explanations for most things, here's something that comes to us from ages ago.

(PETER SALGO) Yeah, I know. And it's surprising that, suddenly, something that people knew, then we dismissed, actually turns out to be true.

(DR. ILAN WITTSTEIN) Turns out to be true. And it can look an awful lot like a heart attack. In fact, years ago, when people were diagnosed with this, they were told they had a heart attack even though it was actually broken heart syndrome. So I'm not surprised you were told you had a heart attack. But there are some big differences.

(PETER SALGO) Now who gets it, typically?

(DR. ILAN WITTSTEIN) Typically, it's women. About 90% of the reported cases are women. And they tend to be a bit older.

(PETER SALGO) Okay.

(DR. ILAN WITTSTEIN) After the age of 55, your risk goes up about five times compared to women under 55.

(PETER SALGO) And that's postmenopausal.

(DR. ILAN WITTSTEIN) Postmenopausal women.

(PETER SALGO) And the relationship between menopause and broken heart syndrome is...?

(DR. ILAN WITTSTEIN) Well, we think that there's a very intriguing relationship. We know that estrogen actually has a lot of very important properties in helping to protect the heart and improving blood flow to the heart, and we think that, as women age and those female hormone levels decrease, they're more susceptible to the effects of stress.

(PETER SALGO) Let me put you on the spot, because we used to think that estrogen protected you against ischemic heart disease and heart attack. The Women's Health Initiative pretty much dismissed that. So are we back with this bugbear of estrogen again in heart disease? What's the difference?

(DR. ILAN WITTSTEIN) Well, I think we are. You know, there are two separate issues. One is, is estrogen helpful And I think the answer is yes. That's why women get heart disease later in life than men do. The second part of that is, should we replace hormones? And the answer is maybe not because it can lead to other problems like cancer and blood clots and so on.

(PETER SALGO) Can you screen people either physically or psychologically to see who's at risk?

(DR. ILAN WITTSTEIN) Screening for this is very difficult, actually, because we always meet people after they've had an event.

(PETER SALGO) Is that a no?

(DR. ILAN WITTSTEIN) That's a fancy way of saying no, yeah.

(PETER SALGO) Are there psychological profiles you would screen for, Sam?

(DR. SAM SEARS) No, I wouldn't be going looking for this in cases like this. I think it probably relates to all of us paying some attention to psychologic wellness as opposed to simply looking for psychopathology.

(PETER SALGO) What about genetics? Does it run in families?

(DR. ILAN WITTSTEIN) It does, actually. Or I should say, it can. It's been reported. There are cases of sisters who have developed this. There are cases where mothers and daughters have had it. But, of course, with situations like that, we don't know how much of that is genetic, how much of that is environmental.

(PETER SALGO) Now, before we go any further, one of the fun things for a doctor is to have a funny name for a disease that relates to something totally bizarre. This is also known as takotsubo syndrome.

(DR. ILAN WITTSTEIN) Yes.

(PETER SALGO) It's from the Japanese word for an octopus trap.

(DR. ILAN WITTSTEIN) That's right.

(PETER SALGO) Now, you brought some pictures. Let's see why it's called takotsubos disease. First, I think you brought us a picture of what a normal heart looks like when it's beating.

(DR. ILAN WITTSTEIN) Yeah, this is a ventriculogram that we're looking at now. This is where we actually take a catheter, and we put it inside the left ventricle, which is the main pumping chamber of the heart.

(PETER SALGO) That black line is a hollow tube.

(DR. ILAN WITTSTEIN) That black line.

(PETER SALGO) And they're injecting dye.

(DR. ILAN WITTSTEIN) Correct.

(PETER SALGO) Radiopaque dye. And that's an x-ray of a normal heart beating.

(DR. ILAN WITTSTEIN) That's a normal heart. And you can see, as the dye fills that heart, the heart squeezes. And all that dye gets ejected, but all the walls of the heart are squeezing very normally.

(PETER SALGO) So it's symmetrical.

(DR. ILAN WITTSTEIN) Symmetrical.

(PETER SALGO) And I would like to point out, the dye is coming out of there in a fabulous hurry.

(DR. ILAN WITTSTEIN) Absolutely.

(PETER SALGO) Zipping up the aorta where it belongs. We like this heart.

(DR. ILAN WITTSTEIN) We like this heart. This is a healthy heart.

(PETER SALGO) Now let's see the next picture that you brought. Now that thing on the right, that piece of pottery has a name. That is an octopus trap.

(DR. ILAN WITTSTEIN) Yes.

(PETER SALGO) And that is called a takotsubo.

(DR. ILAN WITTSTEIN) That is a takotsubo, yes. That is apparently what they use in Japan to trap octopus. And the idea is that the octopus goes in the open mouth there and has a hard time getting out.

(PETER SALGO) Or it just likes living on the bottom. One or the other.

(DR. ILAN WITTSTEIN) That's right.

(PETER SALGO) But that's how they catch octopus to eat it. But the picture on the left...

(DR. ILAN WITTSTEIN) Yes.

(PETER SALGO) ...is really intriguing 'cause we just saw a heart beating symmetrically. Tell me what we're looking at on the left.

(DR. ILAN WITTSTEIN) Yeah, so you're looking at, again, a ventriculogram. Again, there's that tube that's sitting inside the heart, injecting the dye. But this time, what we see is that half of the heart – and you sort of -- about the midpoint of that picture to the left is squeezing very well, and it gives you that kind of narrow tube-like appearance. And then, from sort of a point forward, you have this ballooning out of the heart itself. So you've got different parts of the heart squeezing. Some parts are squeezing well. Some parts are not squeezing at all.

(PETER SALGO) Ergo, it looks like...

(DR. ILAN WITTSTEIN) It looks like a takotsubo. Yeah.

(PETER SALGO) Who on Earth picked that up? I mean, would I have looked at that picture and said, "Why, that's an octopus trap?" I don't think so.

(DR. ILAN WITTSTEIN) Well, it was described initially in Japan, and that's where they use takotsubo, so I guess...

(PETER SALGO) And you also brought yet one more set of pictures, I think, which shows this all in motion.

(DR. ILAN WITTSTEIN) Yeah, so here is a patient who actually had a stressful day and came in with chest pain and shortness of breath. And now we -- we're looking at a ventriculogram again. There's that hollow tube in the middle. It's injecting dye. And, again, we can see...

(PETER SALGO) I -- I... It's gonna play again and again. So we'll look at the top of the heart...

(DR. ILAN WITTSTEIN) Yeah.

(PETER SALGO) Which is gonna be skinny and normal.

(DR. ILAN WITTSTEIN) Mm-hmm.

(PETER SALGO) And the bottom of the heart balloons out.

(DR. ILAN WITTSTEIN) Balloons out and isn't squeezing.

(PETER SALGO) So with every beat, it's forming that picture that looks like an octopus trap.

(DR. ILAN WITTSTEIN)  Absolutely.

(PETER SALGO) Ergo, takotsubos.

(DR. ILAN WITTSTEIN) Mm-hmm.

(PETER SALGO) We had to take the time to show this. That was too good not to show. The important thing here is, you got better. Do people with takotsubos just get better? And what do you do to make them better?

(DR. ILAN WITTSTEIN) Yeah, so when people ask,

"Can you die of a broken heart," the answer is yes, because, as we're seeing on those pictures,

when you first come in with this, the heart can look incredibly weak. It can be not pumping blood to the rest of the body. You can have fluid in your lungs like you did. People can have very low blood pressure. In the most serious cases, people can have to be supported on life support in order to get through this. But what's fascinating about takotsubo is that the heart tissue is not permanently injured. It's stunned, which means that, if you can support a person for a short while, the heart muscle starts to recover. And one of the hallmark features of this is that the heart muscle actually returns to normal.

(PETER SALGO) I think we have one more set of pictures to show, unless I'm mistaken. And we'll put them up to show a sick heart and a happy heart.

(DR. ILAN WITTSTEIN) So what we're looking at here is an echocardiogram. So this is an ultrasound picture. And we're looking at the heart. We're cutting through the heart as if we're slicing it like a doughnut. And you can see on the left side, this is someone on the first day that they came in. They came in with chest pain, shortness of breath very much like you did.

(PETER SALGO) This is the broken heart.

(DR. ILAN WITTSTEIN) And this is the broken heart on the left side here where that heart muscle's really not squeezing very well at all. And this is a picture just one week later. So this is only a week after the initial presentation. And the heart on the right is -- not only is it smaller, but it's actually squeezing very well. So it's fully recovered in just one week.

(PETER SALGO) Happy heart, right, unhappy heart, left. Okay. How long were you in the hospital? What did they do for you?

(MARYANN MURRAY) Three days.

(PETER SALGO) That's it?

(MARYANN MURRAY) Yep.

(PETER SALGO) And what did they say? And what medicine did they give you, anything?

(MARYANN MURRAY) They changed -- I was on blood-pressure medicine. They changed the blood-pressure medicine. And they gave me another medicine for the heart. But then my heartbeat wasn't work-- it wasn't working right, and then they took away the one medication. They just left me on the blood-pressure medication.

(PETER SALGO) And it went away.

(MARYANN MURRAY) And it went away.

(PETER SALGO) Does this happen over and -- Are you worried it's gonna happen again?

(MARYANN MURRAY)  Yeah, sometimes. I don't dwell on it, but, you know, you always wonder.

(PETER SALGO) Does stress management, Sam, play a role in controlling recurrence of this?

(DR. SAM SEARS) I think it does. I mean, that's a plan that would be comprehensive. There's a medical management plan. There also needs to be a psychologic management plan. So attending to the kinds of stressors that you are facing, maintaining, if you will, a psychologic monitoring and maintenance plan. That is, keep yourself feeling well and engaged and, I think, other strategies, like ways that you cool your jets, ways that you kind of let go of some stress maybe at the end of the day and putting systematic plans in place.

(PETER SALGO) Is her concern that it will happen again rational? Does it happen twice?

(DR. ILAN WITTSTEIN) It can happen twice. I'll start by saying that the majority of people that we've followed to this point -- And again, this syndrome hasn't been around for 50 years. But up to this point, we can say that the majority of people have not had a second episode.

(PETER SALGO) Mm-hmm. But let's be very clear. The syndrome has probably been around for thousands of years.

(DR. ILAN WITTSTEIN) Correct.

(PETER SALGO) We've only recognized it since your paper.

(DR. ILAN WITTSTEIN) That's right.

(PETER SALGO) Now, Lou, you're out there in the real world.

(DR. LOU PAPA) Right.

(PETER SALGO) You see all the folks who come in with takotsubos.

(DR. LOU PAPA) Right.

(PETER SALGO) And it's easy for everybody to say, "Oh, stop worrying." But these people worry.

(DR. LOU PAPA) They do worry. And I think one of the big messages is, it's not my responsibility, it's not your responsibility to figure out if it's takotsubos. If you've got chest pain and shortness of breath, it's up to these guys to kind of evaluate what kind of heart disease it is, 'cause it's all serious.

(MARYANN MURRAY) Mm-hmm.

(DR. LOU PAPA) And I think -- And Sam -- Sam's... You know, hear me out on this. The stress issue is important kind of across the board with any chronic illness, whether it's takotsubos or it's general coronary artery disease. So it's very true. These patients worry about -- You have some patients who, after their heart attack, they're terrified to step off a step because they don't know if that's gonna trigger a heart attack.

(PETER SALGO) So, it sounds to me as if you've got another stressor. You had all of this stuff -- caregiver -- all the stress in your life. And now you're worried about stress causing heart disease, and that's stressing you out. How do you deal with that?

(MARYANN MURRAY) Um, I try not to think about it. But I, uh, I try to keep busy.

(PETER SALGO) Yeah.

(MARYANN MURRAY) I try to get out. I walk every day and, uh, just get out and, uh, visit people. And I've joined some clubs. And I'm just trying to not get so stressed.

(PETER SALGO) Let some of the pressure out.

(MARYANN MURRAY) Yes. Yes.

(PETER SALGO) Do you guys have any advice? Sam, do you have any practical advice?

(DR. SAM SEARS) Well, I think she's making all the right moves, it sounds like to me -- engaging in life, focusing on activities of peace and tranquility, focusing on activities that make you feel alive, well, and vigorous...

(MARYANN MURRAY) Right.

(DR. SAM SEARS) ...engaging in relationships that are nurturing to you and that you can engage in, you know, family and friends. I think those are all the right steps. But the idea here is, just like you have physical wellness strategies, these are psychologic wellness strategies.

(MARYANN MURRAY) Right. Right.

(PETER SALGO) Any cardiology strategies you got?

(DR. ILAN WITTSTEIN) You know, I think that, uh, at this point, despite the fact that we've been looking at people with the syndrome now for 10, 15 years, uh, we still don't know all the answers as to what's the best thing to do. And people have done a lot of creative things. I've had patients who have quit stressful jobs...

(PETER SALGO) Yeah.

(DR. ILAN WITTSTEIN) Because they wanted to remove themselves from the situation. I've had patients who've tried yoga, tai chi, biofeedback, a lot of different things like this. And we don't have big studies to say that that's helpful. But sometimes you don't need a study to say that that makes good common sense. And if it works for that individual, uh, we recommend it.

(PETER SALGO) Lou?

(DR. LOU PAPA) I think, like with any disease, especially with heart disease, making sure that you -- you define the disease and it doesn't define you is very important. Risk factor modification is very important, making sure all the things that can contribute to the heart disease are modify -- modified. And if there are things that you knew were stressful, just like Ilan said, it's just prioritizing that, making a change, uh, to make sure that you're feeling well overall. That's true for any disease.

(PETER SALGO) I am thrilled you're better. I'm thrilled you didn't have a heart attack.

(MARYANN MURRAY) Thank you.

(PETER SALGO) And I'm thrilled you came here to visit with us. Thank you so much. And panel, great discussion.

(MARYANN MURRAY) Thank you for having me.

(PETER SALGO) Thank all of you for being here, as well. Now we're gonna go to this week's "Second Opinion 5."

(DR. LEWAY CHEN) Hello. I'm Dr. Leway Chen. I'm here to tell you five things about broken heart syndrome. First, broken heart syndrome is a real disorder that surprisingly can occur in many people. This syndrome can mimic a heart attack and cause severe dysfunction of the left ventricle, which is the main pumping chamber of the heart. You can, in fact, die of a broken heart. Second, it has many names, including stress-induced cardiomyopathy, apical ballooning syndrome, and takotsubo cardiomyopathy. Third, this syndrome is caused by a surge of stress hormones, such as adrenaline, often triggered by a severe emotional or physical event, such as death of a loved one, a bad romantic breakup, or even the shock of a good surprise. Fourth, women are much more likely to experience this syndrome than men -- nearly 9:1 ratio. Predominantly, this occurs in postmenopausal women. The signs and symptoms of broken heart syndrome may be similar to a heart attack, chest pain, shortness of breath, and irregular heartbeats. Anyone experiencing these symptoms after severe emotional or physical stressor should seek medical attention. Finally, although broken heart syndrome in some cases can lead to death, the majority of people will recover completely. There are treatments for broken heart syndrome, but the diagnosis should be made in a timely fashion to differentiate from a true heart attack. And that's your "Second Opinion 5."

(PETER SALGO) Thank you so much for watching. And remember, you can get more second opinions and patient stories on our website at secondopinion-tv.org. You can continue the conversation on Facebook and Twitter, where we are live every day with health news. I'm Dr. Peter Salgo, and I'll see you next time for another "Second Opinion."

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(NARRATOR) "Second Opinion" is produced in conjunction with UR Medicine, part of University of Rochester Medical Center, Rochester, New York.