Broken hearts are for real

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DEAR DR. DONOHUE: Last August, I was admitted to the hospital with what the doctors thought was the beginning of a heart attack. The next day I had a heart catheterization and found out I did not have a heart attack. I had something known as takotsubo cardiomyopathy. I am recovering, but I often hear from medical professionals that they’ve never heard of this diagnosis. I feel your readers would be interested in learning about it. In my case, it was probably brought on by my husband’s major heart attack. — R.T.

ANSWER: Takotsubo cardiomyopathy, or broken heart syndrome, is a true heart condition brought on by emotional or physical stress. The stress can be the unexpected death of a close loved one, or it can be physical stress like major surgery. The triggering event causes the body to release “stress” chemicals that have a deleterious effect on heart muscle.

Cardiomyopathy, by definition, is damaged heart muscle without heart artery obstruction or heart valve problems. The stress chemicals weaken the muscle of the heart’s main pumping chamber, the left ventricle. The heart becomes a feeble pump of blood.

People with this condition have signs and symptoms of a heart attack. Their chest pain is like the chest pain of a heart attack. Shortness of breath results from the lack of oxygen and circulating blood. The EKG reveals changes that raise suspicions of a heart attack

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Heart catheterization, however, discloses normal heart arteries without any blockages as found in a heart attack. The catheterization involves injecting dye into heart arteries to visualize them on X-rays.

Treatment involves using the drugs often used for a heart attack — ACE inhibitors, beta blockers and diuretics.

The heart recovers and pumps as strongly as it did before the event took place. Broken heart syndrome is an appropriate name for this condition.

 DEAR DR. DONOHUE: My doctor tells me I have an anal fissure. What is it? Does it involve an operation? I was told to use stool softeners and apply Nupercainal ointment. Will they help the itch and pain? — G.G.

 ANSWER: An anal fissure is a straight-line tear in the lining of the anus. It’s like a paper cut on a finger, but it is longer, deeper and wider. That area is supplied with a vast network of nerves, and is, therefore, very sensitive. An anal fissure is quite painful and may itch. The cause? Most often, having to strain to eliminate rock-hard stools.

 You’re doing the right things. Stool softeners will keep your movements moist and soft. If the fissure doesn’t heal with your current treatments, you can hurry the process along by taking sitz baths. A tub is filled with warm water to a level that bathes the affected area. You simply sit in the water with your knees bent and the heels of your feet drawn toward your buttocks. Fifteen minutes of sitting, twice a day, speeds healing. Nitroglycerin ointment, the same kind of nitroglycerin used for angina chest pain, increases blood flow to the fissure and hastens healing, too.

 Only when these measures fail is surgery needed.

 DEAR DR. DONOHUE: I have wet macular degeneration in my left eye. It was discovered after cataract surgery. My eye was scratched during the surgery. Later, my eyelids were measured for cosmetic reasons. The technician hurt mine while measuring my left eye. Could either have caused the macular degeneration? — Z.D.

 ANSWER: Neither the scratch that occurred during surgery nor the injury during eyelid measurement caused your wet macular degeneration. It comes from the sprouting of new and fragile blood vessels under the retina. The macula is a small part of the retina having the densest concentration of vision cells. It’s responsible for keen central vision, the kind needed for reading, distinguishing faces and doing fine work, like sewing.

 Leakage of blood and fluids from these newly formed blood vessels causes wet macular degeneration.

 What made the vessels grow is a question for which a good answer isn’t forthcoming right now.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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