Can Stress Kill?

by Jennifer Carlquist, PA-C

Ms. X was a was healthy 51-year-old female when she died. She reported being “very busy” all the time taking care of a household. She was taking care of her three grown children who had moved back in with her along with her grandchildren and her husband while working a full-time job. The morning of her cardiac arrest, she noticed that she felt a little “lightheaded” but paid it no mind as she was always tired, and thought maybe she was just hungry. After all, she had just taken a “small walk” with her daughter and felt a bit short of breath, which was odd for her. She went home she ate a bowl of cereal and developed a sharp pain in her chest. She started walking around, she felt it wasn’t going away. She told her daughter to call 911.

She remembers “coming to” when they were cutting her clothes off in the ER. She had one shock en route to the ER that restored normal sinus rhythm. She had a cardiac catheterization that showed normal coronary arteries, but the images were consistent with Takotsubos cardiomyopathy that was confirmed with an echocardiogram that confirmed her low EF of 30%. Takotsubo is a stress-induced cardiomyopathy that is temporary. It is usually triggered by the death of a loved one or acute emotional stress and is also known as Broken Heart Syndrome. The patient with Takotsubo’s cardiomyopathy will have EKG findings consistent with STEMI, and the diagnosis can only be made during an angiogram. Patients usually recover fully with maximal medical management, and decreasing stress in a few weeks to months. This patient was discharged on Metoprolol, Lisinopril, and Lasix.

On her two-week post hospital follow up, the first question she had was “When can I start ironing again?” Her husband was doing all the ironing and she was eager to start being helpful again to her family as she had always been. Once she was made aware that her constant stress and overdoing it led to her illness, she prioritized taking care of her own health first. Her ejection fraction eventually normalized, and she is doing well.

Stress is a bigger player in cardiac disease than we realize. It is important to check in with our patients to make sure they are managing their stress well. This is one of the newest risk factors on the horizon in the heart disease arena.

See Jennifer Carlquist, PA-C speak at the GAPA 2019 Summer Conference in Hilton Head Island, SC.

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