Genes R US — Broken heart syndrome: Genetic markers for coronary heart disease

Posted: Wednesday, August 15, 2012 5:00 pm

Both the heart and the brain are critical for life. Most of you reading this column already know that if something is good for your heart, it is good for your brain — and vice versa.
People are pretty open about sharing a heart condition and fairly faithful about taking their heart meds. However, many people are much less open about brain conditions, like depression and anxiety that if left untreated may damage the heart, as well as shrink the brain. (Yes, shrink!)
The brain and the heart are intimately connected. This is especially true of broken heart syndrome, also known as takotsubo cardiomyopathy or stress cardiomyopathy. The Japanese cardio-research community was the first to perform a scientific study of this real phenomenon, which primarily affects post-menopausal women. Broken heart syndrome is often diagnosed as an acute myocardial infarction because the patient presents with the symptoms of a heart attack. But emotional stress is not the only trigger, an infection or other severe bodily insult can also trigger this condition.
Another not so well known heart “dis-ease” is stress-related coronary spasms. A spasm slows or stops the flow of blood through the heart when an artery squeezes shut and fails to relax and open up again. No blood clots are involved.
Coronary spasms feel like an elephant is sitting on one’s chest with pain radiating down one’s arm, or perhaps a severe pain between the shoulder blades with jaw pain … pretty much like a classic heart attack. The sensitive cardiac enzymes that are used as biomarkers of heart injury are elevated, too, with cardiac spasms and broken heart syndrome.
For premenopausal women, the timing of spasms usually occur when estrogen levels are lowest in their monthly cycles; for post-menopausal women, the spasms occur most frequently in those women that are not on estrogen replacement.
Coronary spasms most frequently occur when the patient is at rest or asleep — there is often no plaque build-up in the arteries. Women younger than 50 years of age who have a heart attack are more likely to have had coronary spasms.
So what is the estrogen connection? Estrogen helps to keep the arteries elastic and relaxed by increasing the affinity for nitrous oxide in the cells that line the vascular system.
Angiograms are used to check for blood flow blockages. When the angiogram finds no heart flow blockage and the MRI shows no damage to the heart, broken heart syndrome or cardiac spasms could be the cause of what appeared to be a heart attack at the onset.
Despite the life-threatening nature of broken heart syndrome or cardiac spasms during the acute phase, a complete recovery is with meds to open the arteries back up. This was the case for me more than 10 years ago.
Since scientists need large numbers of people with a syndrome or disease to be able to determine genetic risk factors, we don’t have much information on the genetics of broken hearts and coronary spasms. For now most studies are those with classic CHD and arrhythmias. African-Americans and South Asians (think India and bordering countries, Thailand, Vietnam) have more CHD events than Caucasians. Caucasians have more than East Asians (China, Japan, and Korea). Men also have a higher risk of classic CHD than women.
There are many genetic risk factors published for CHD. 23andme.com tests for just a few with the vast majority from research performed on Asians. I show up with typical risk for CHD and arrhythmia for the established research based on less than a dozen SNPs (single-point DNA variations).
I have substantially higher odds of developing CHD than average using another half-dozen preliminary SNPs on 23andme and the newest SNPs that have not even made it to 23andme. I have low blood pressure, normal cholesterol, average weight, and I have never smoked.
My birth mother has had congestive heart failure, i.e., a weakened heart, for over 20 years. She has had high blood pressure and high cholesterol since her mid-30s. Like most smokers, she self-medicated for anxiety and depression for most of her life — the worst thing one can do with a genetic predisposition for CHD.
My genetic CHD risks are higher than those of my birth mother who also had a stroke eight years ago from a block carotid artery.  By the way, she was slim, young looking.
Most people think of coronary heart disease in terms of heart blockages. Most people don’t know that broken heart syndrome and coronary spasms can starve the heart for oxygen-rich blood, too. The great thing about surviving a cardiac episode (or two) is that it provides an opportunity to evaluate one’s priorities and the meaning of life. But just because one’s angiogram is clear and their heart muscles are not permanently damaged, don’t deny what has happened.
Your heart may be trying to tell your brain something that it does not want to hear. Listen while you can.
Nancy@NancyMiller Latimer.com has worked in scientific research and development for 27 years. She blogs at NeuronalBeauty.BlogSpot.com. Published in The Messenger 8.15.12