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Study Offers Clues to 'Broken Heart Syndrome'

events but don't develop Takotsubo cardiomyopathy," Dr. Regnante said.

A surge of stress hormones likely plays a role, he said, but it is also possible that a blood clot temporarily blocks a major artery of the heart, then dissolves before being detected during coronary angiography.

The most common symptom of broken heart syndrome was chest pain, in 70 percent of patients, followed by shortness of breath in 33 percent. All patients had ECG changes suggestive of an acute coronary syndrome, a term that encompasses both heart attack and unstable angina. Troponin-I, a blood test for heart damage, was positive in 95 percent of patients.

Twenty percent of patients were unable to breathe on their own and needed a respirator. In all patients, cardiac catheterization showed characteristic abnormalities in the motion of the heart. One patient died of acute heart failure.

The good news is that most patients who survived the first 48 hours had a steady recovery. Thirty one, or 78 percent, of patients had follow-up echocardiography within a few weeks. Heart function was found to be normal in 29 of 30.

Dr. Regnante said that long-term follow-up will be critical to improved understanding of Takotsubo cardiomyopathy. In addition, he and his colleagues are gathering information on patients who have intravascular ultrasound during cardiac catheterization. This imaging test, in which a tiny ultrasound probe is threaded into the coronary arteries on the tip of a catheter, may show whether the patient has clogged arteries or unstable plaques that are not visible on coronary angiography. These findings will help guide long-term treatment.

"Because we don't yet know what causes this phenomenon, we don't know what the best long-term management should include," he said. "As we gather more information on these patients, we can start to understand who is affected by Takotsubo cardiomyopathy, offer more focuse
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