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18 December 2008

Takotsubo Troubles

There's a medical condition in the literature known as Takotsubo Cardiomyopathy. It's basically broken heart cardiomyopathy where extreme grief or stress can actually lead to heart failure. It's been well documented in elderly widows who have chest pain or pressure at some point after losing their spouses. One of my favorite shows, "Scrubs," actually had the diagnosis as one of their story lines.

I think I might have written about the multitude of OD's we were seeing in the days following Thanksgiving (60 Hours), but lately it's seemed like I'm seeing a lot of depressed patients who come into the E.D. just for some companionship, or to have someone to talk to for a while. I did have two women who came in that made me think of Takotsubo's.

The first was a woman whose chief complaint was: chest pain. About 2 minutes after I started talking to her, I realized that her heartache was more of the emotional kind than the physical kind. She made a comment about all the "pressures" in her life at this time. When I pressed about them, she started crying and told me about how her fiance had died the year before, and how the holidays had always been a very special time for the both of them. They had been together for 8 years. She had family she wasn't really close to, and he had no one. They had each other.

She told me how she had seen him die right in front of her in a freak accident. One minute they were walking along, joking and laughing; the next, he had fallen down an embankment and died as a result of the fall. They had just gotten engaged and had not even gotten around to setting a date. I still had to work her up as a potential Acute Coronary Syndrome, but I ended up discharging her home with follow-up to counseling and psychiatry.

The second little lady came in this evening as I was trying to wrap things up at the end of my shift. Her chief complaint was "weakness." As I talked to her, she had some very non-specific symptoms: some nausea but no vomiting, some general feelings of "just being sick," and a feeling in her stomach that wasn't pain, and wasn't related to anything else. When I pushed her on it, she stated that she thought she might be lonely.

She lives in Senior Apartments. She doesn't like seeing ambulances coming and going at all hours. She's proud of her children and their accomplishments but calls them "work a holics" who don't have time to visit. She says her apartment is by the lake, but too much moisture which makes her bones ache. She said just being in the E.D. made her feel better. She told me that her physician told her that "loneliness will make you sick" and maybe that's all that is going on with her now.

When I signed her out at the end of my shift, I brought up Takotsubo's. My colleagues chuckled, but I'll think of this scene in "Scrubs" as I go to bed tonight; lying on a bed surrounded by three warm and purring kitties. Charles Schultz in "Peanuts" once said that "Happiness is a warm puppy." Too bad I can't write a prescription for a box of kittens or a warm puppy.


cw2smom said...

This hits home with me as I have a dear male friend that I've written about (Cave Man) who is so isolated and lonely. I told him yesterday.."If you aren't livin' you are dyin'!" and he had to agree. His family is the same as what you described here. However, he's a loner, and prefers solitude somewhat. But, right now, he's sick with an intestinal infection, depressed and lonely on top of it. It's sad. Especially for older people during the holidays. As much as I wish my kids were on their own, I am sure it wouldn't be all that wonderful to be totally by myself! Thank Goodness that you have compassion and understanding for your patients. Regarding step-grandfather died within a week of my Grandmother. They'd been together for so long, I don't believe he wanted to sticka around after she left. He went out for some groceries, set them on the counter, then must have felt bad and laid on his bed. They found him that night when he didn't show for dinner with a neighbor! Sad, but I can understand. Blessings for a great holiday! Lisa
Verification word: barofa! Certainly a medical term, you think? LOL!

ADB said...

Only goes to show that the holidays can be a very sad time for many lonely people, Veronica

I'm mostly known as 'MA' said...

We know that the greatest need is for love. Love can cure many things. 'On Ya'-ma

Jeanie said...

My elderly neighbour lost his wife two years ago. He lives alone now as his son lives at the other end of England outside London. He comes to see him every five weeks or so but they don't get on. They are too alike. He would rather be on his own and yet he lets me call on him every day for an hour since he had a car accident last May.
I could never see him being alone every day again. I would feel awful if something happened to him.
I'm off up there now to visit.
He now gets vitamin B12 injections as he was very aneamic when he was tested after his accident.
It's so sad that some people get ill through loneliness. So very sad.
Jeanie xxx

garnett109 said...

it is easy for a broken heart my mom just passed and i can see how that can affect your heart!

Claudia's thoughts said...

My in laws died within six months of each other.....If some one had told me that Joe would be dead in that time at his wife funeral I would have never believe it. The funeral director said that it is not that uncommon.......My father died 9 years after my mom, he was so lonely. If he could have lay down and died he would. It is sad for them when their life companion is gone. My dad said your perspective of life changes when you get old.....he was ready to go. I guess I will know about that when I get there.

a corgi said...

I hadn't heard of this before but it makes perfect sense; I know there are so many lonely and sad people out there and the holidays do seem to bring them all out especially if they remember previous holidays when their loved ones were there or their kids were little

its good you listened to them as you were working them up; I bet that meant a lot to them just to be able to talk and share their stories


Anonymous said...

oh wow.... :((

erarein63 said...

Oh we see it too, sad. I think an Rx for a puppy would be great! De ;)

Kathy said...

you don't have to be elderly to be alone and lonely. or to have lost a partner to have a broken heart.

thank goodness for nurses like you.