Broken Heart Research Articles

Takotsubo Cardiomyopathy with Immune-Mediated Comorbidities: A Case Report

Abstract Background Takotsubo cardiomyopathy (TCM) is an under-recognised cardiovascular syndrome, leading to myocardial infarction and left ventricular systolic dysfunction, in the absence of detectable coronary artery lesion. The pathophysiologic mechanisms underlying the condition remains unclear. Whilst previously believed to be a result of circulating high levels of catecholamines due to preceding severe emotional or physical stress, giving it its colloquial name of ‘broken heart syndrome’, newer evidence suggesting accompanying systemic inflammatory activation hints at a mechanism of acute stress encounters serving as the trigger for an enhanced systemic and hence myocardial inflammation. Case summary In this report, we present a 72-year-old female patient presenting to ED with sepsis, whose echocardiogram upon admission showed the entire mid and apical segments of the left ventricle (LV) as akinetic, with residual contractility only on the basal segments, suggestive of Takotsubo Cardiomyopathy (TCM) as a likely diagnosis. This is on a backdrop of a complex history of autoimmune and chronic inflammatory comorbidities, including type 1 diabetes, asthma, sarcoidosis, primary biliary cholangitis, Sjogren’s syndrome, and type 3 cryoglobulinaemia. Discussion In line with previous reports, this adds to the evidence base for the potential immune-mediated pathophysiology of Takotsubo cardiomyopathy, highlighting inflammatory activation as causative as opposed to consequential to TCM, given its greater propensity for development of the disease in low-grade chronic inflammatory states. This identifies an understudied aspect of its aetiology, warranting further clinical and mechanistic investigation with implications for treatment and prophylaxis. Additionally, this highlights an important differential for acute myocardial infarction, in patients with underlying chronic inflammatory and autoimmune diseases.

Prolonged Grief Disorder: A Narrative Review

The prevalence of Prolonged Grief Disorder has ranged from 7% to 65% in different samples depending on the severity of the grief experience. A narrative review of the current literature (2024-2025) on Prolonged Grief Disorder has yielded papers on negative effects, risk factors, potential underlying biological mechanisms and interventions. The negative effects include loneliness, poor quality of life, depression, PTSD, psychosis and broken heart syndrome. The risk factors have included anxious attachment, rumination, anxiety, PTSD, insomnia, COVID, earthquake, terror, and relationship to the deceased. The potential underlying biological mechanisms have included oxytocin dysfunction and involvement of the nucleus accumbens (the reward region of the brain). Cognitive behavioral therapy has been the most frequently researched intervention.

Cardiovascular Risk Profile of Nivolumab Anti-cancer Therapy: A Review of Current Literature.

Immune checkpoint inhibitors (ICI) upregulate host antitumor immunity, proving efficacy across diverse tumor types. Currently approved ICI treatment primarily targets the programmed cell death receptor 1 (PD-1) and its ligand PD-L1, and cytotoxic T lymphocyte-antigen 4 (CTLA-4). Nivolumab is a monoclonal antibody that targets the human PD-1 receptor and is an entirely human immunoglobulin G4 (IgG4), approved by the FDA for various cancers like advanced melanoma, metastatic renal cell carcinoma, Hodgkin lymphoma, and advanced lung carcinoma. This review will summarise and discuss the recent literature on cardiotoxicity associated with nivolumab therapy. We searched online databases like PubMed, Scopus, Google Scholar, and Embase for articles related to Nivolumab. Cardiotoxicity with ICI use is most commonly represented as myocarditis. Patients present with complaints of shortness of breath, palpitations, edema, and fatigue. Takotsubo cardiomyopathy, or broken heart syndrome, is characterized by systolic dysfunction of the left ventricle, mimicking a myocardial infarction but without associated coronary ischemia and with minimal elevation of cardiac enzymes. In the CHECKMATE-037 trial, ventricular arrhythmias occurred in <10% of those who received nivolumab. In a retrospective analysis of patients treated with ICI (predominantly nivolumab monotherapy) for lung cancer, 11% of the patients developed major adverse cardiac events, including myocarditis, non-ST-segment elevated myocardial infarction, supraventricular tachycardia, and pericardial disorders. Close collaboration between cardiology and oncology specialists is crucial for early detection and effective management of cardiac complications, enhancing the safety of nivolumab anticancer therapy.

The "Ins and Outs and What-Abouts" of H2A.Z: A tribute to C.David Allis.

In 2023, the brilliant chromatin biologist C. David Allis passed away leaving a large void in the scientific community and broken hearts in his family and friends. With this review, we want to tribute Dave's enduring inspiration by focusing on the histone variant H2A.Z, a nucleosome component he was the first to discover as hv1 in Tetrahymena. We summarize the latest findings from the past 5years regarding the mammalian H2A.Z histone, focusing on its deposition and eviction mechanisms, its roles in transcriptional regulation, DNA damage repair, chromatin structure organization, and embryonic development, as well as how its deregulation or mutation(s) of its histone chaperones contribute to disease development. As Dave liked to say 'Every amino acid matters'; the discovery and characterization of functionally different H2A.Z's isoforms, which vary only in three amino acids, prove him-once again-right.

From blunt chest trauma to broken heart: imaging features of a neglected diagnosis

Abstract Background/Introduction Blunt chest trauma is a leading cause of mortality, with a significant portion of deaths attributed to cardiac injuries. These cardiac injuries can range from mild contusions to life-threatening ruptures. Imaging plays a crucial role in evaluating suspected cardiac injury after chest trauma. This study highlights the importance of a comprehensive imaging approach in this critical setting. Purpose This study aims to investigate the presentations and diagnostic challenges of a wide range of cardiac injuries following blunt chest trauma, emphasizing the crucial role of cardiac imaging in identifying these injuries. Methods This study retrospectively investigates patients' presentations, diagnostic challenges, and imaging finding in diagnosing cardiac injuries following blunt chest trauma. We reviewed medical records of thirteen patients diagnosed with these injuries over a twelve-year period. Results Our study investigated cardiac injuries following blunt chest trauma. We analyzed thirteen patients' cases (Figure 1). Tricuspid valve regurgitation was the most frequent diagnosis, affecting seven patients. The potential for delayed presentation makes diagnosing these cases challenging, as patients with this injury may remain asymptomatic for many years following the trauma. One patient had a left main artery dissection (Figure 2 panel D cardiac 3D computed tomography; red arrow pointing to dissection within the distal left main coronary artery at the site of atheroma, with a small vascular outpouching, representing a false lumen) and another patient had severe mitral regurgitation due to partial rupture of the anterior papillary muscle post chest trauma. Additionally, two patients had ventricular septal defects (Figure 2 Panel C cardiac MRI; red arrow pointing to large muscular ventricular septal defect at the mid - apical segment with left to right shunt; LV: left ventricular, RV: right ventricular, LA: left atrium, RA:Right atrium, AA:ascending aorta). We observed another very rare complication post chest trauma an aortic valve aneurysm causing severe aortic regurgitation. Additionally, another patient with a bicuspid aortic valve developed post chest trauma flail and tear of the aortic valve cusp (Figure 2 Panel A, 2D transthoracic echocardiography, parasternal long axis views red arrow pointing to flail and tear of aortic valve cusp, panel B; 2D transthoracic echocardiography with color, parasternal long axis views red arrow pointing to severe aortic regurgitation jet directed towards the anterior mitral leaflet). Conclusion(s) This study highlights the challenges of diagnosing cardiac injuries after chest trauma. It emphasizes the importance of maintaining a high index of suspicion for these injuries in patients with blunt chest trauma. A focused examination and utilization of imaging can improve diagnostic accuracy, guide optimal patient management, and ultimately prevent complications and improve outcomes. Figure 1 Figure 2

ANALYZING THE CONCEPTS OF CONTEXT AND REGISTER IN YOUTUBE CONTENT TED TALKS : WHY BROKEN HEARTS HURT – AND WHAT HEALS THEM BY YORAM YOVEL

This study aims to analyze the role of context and register in the TED (Technology, Entertainment, and Design) titled "Why Broken Hearts Hurt - and What Heals Them" by Yoram Yovell. TED Talks, renowned for their educational and inspirational content, often require a delicate balance between formal presentation and personal engagement. This research employs a descriptive qualitative discourse analysis approach to examine how Yovell utilizes contextual elements and linguistic register to enhance the effectiveness of his communication. The analysis focuses on three main components: the physical setting, participant dynamics, and situational factors influencing the talk. It further investigates the lexical choices, tone, and style employed by Yovell. This study highlights the importance of adapting language and style to fit the context and audience, offering practical insights for speakers and educators aiming to communicate complex ideas effectively.

European Research Council-funded grant: programming the epicardium to cure broken hearts.

European Research Council-funded grant: programming the epicardium to cure broken hearts.

Pharmaceutical Humanities and Narrative Pharmacy: An Emerging New Concept in Pharmacy.

The complexity of our life experiences and the rapid progress in science and technology clearly necessitate reflections from the humanities. The ever-growing intersection between science and society fosters the emergence of novel interdisciplinary fields of research. During the past decade, Medical Humanities arose to meet the need to unravel hidden information beyond technology-driven and fact-based medicine. In the present paper, we put forward the hypothesis that there is a similar requirement to develop Pharmaceutical Humanities as an academic discipline within pharmacy and pharmaceutical biology. Based on Thomas Kuhn's epistemological theory on the structure of scientific revolutions, one may argue that a paradigm change for Pharmaceutical Humanities might open new levels of insight. Many complex diseases (e.g., cancer, neurological diseases, and mental disorders) remain uncurable for many patients by current pharmacotherapies, and the old beaten paths in our therapeutic thinking may at least partly have to be left behind. By taking examples from Pharmaceutical Biology, we attempt to illustrate that the transdisciplinary dialogue with the humanities is fertile ground not only for enlarging our understanding of disease-related conditions but also for exploring new ways of combatting diseases. In this context, we discuss aspects related to traditional herbal medicine, fair access and benefit sharing of indigenous knowledge about medicinal plants, post-traumatic stress syndrome, the opioid crisis, stress myocardiopathy (broken heart syndrome), and global environmental pollution with microplastics. We also explore possibilities for a narrative turn in pharmacy. The urgent need for inter- and transdisciplinary solutions to pressing health-related problems in our society may create a scholarly atmosphere for the establishment of Pharmaceutical Humanities as a fruitful terrain to respond to the current demands of both science and society.

Analisis Alur Mundur pada Novel Perempuan Patah Hati Yang Kembali Menemukan Cinta Melalui Mimpi Karya Eka Kurniawan

This article identifies and describes "The Backward Flow Analysis In the Short Stories of Women, Broken Hearts of Whom Re-Had discovered the Quantitative Love Through Dreams of Eka Kurniawan, the purpose of this research paragraph is to provide information and describe the back dreams contained in this research method. The short story collection is Ginc This Red, Darling, Broken Heart Women Again Finding Love through Dreams, Making Happy A Elephant, Stone Story, Every Dog Can Be Happy, Burning Fire, and keep Parrot Lessons

Happy heart syndrome - The impact of different triggers on the characteristics of takotsubo syndrome.

Happy heart syndrome - The impact of different triggers on the characteristics of takotsubo syndrome.

Takotsubo Following Severe Anaphylactic Reaction during Anesthesia Induction

Introduction: Takotsubo cardiomyopathy (apical ballooning or broken heart syndrome) is a reversible left ventricular dysfunction due to apical asynergy that occurs typically after sudden emotional stress in a subject without coronary disease. Anaphylaxis is a severe, life-threatening, generalized hypersensitivity reaction, most often starting with urticaria and/or angioedema, that may involve cardiovascular and respiratory systems. Cardiovascular symptoms, including hypotension, cardiac arrhythmia and chest pain, are presumably linked to cardiac mast cell mediator release. Case Report: We describe the case of a woman who experienced a profound reversible cardiomyopathy with typical features of Takotsubo's syndrome during an anaphylactic reaction. Conclusion: Exposure to catecholamines and beta-receptor agonists used routinely during procedures and diagnostic tests can precipitate all the features of stress cardiomyopathy, including cardiac isoenzyme elevation and rapidly reversible cardiac dysfunction. These observations strongly implicate excessive sympathetic stimulation as central to the pathogenesis of this unique syndrome.

Customer Segmentation Based on Rfm Analysis as The Basis of Marketing Strategy Case Study of Crude Palm Oil Product in Palm Oil Industry

Nowadays so many palm oil companies sell the product to potential buyer to maximize their revenue, so they need to understand the customer's data better in all aspects. Segmenting the customers according to their data became extrem important in this context. This study aims to explore customer segmentation using RFM (Recency, Frequency, and Monetary) analysis as a basis for developing an effective marketing strategy for Crude Palm Oil (CPO) products in the palm oil industry. In this paper, i used data of crude palm oil sales database that obtained from digital platform named Customer Relationship Management (CRM) System and Auction by E-commerce involving 56 buyers by 2.499 transactions. After the scoring and data processing, the number of customers for each RFM Score is obtained, then the Monetary group is segmented which is divided into 27 Labels and grouping to 11 (eleven) Labels of Buyer’s Company, Engaged (8), Loyal (9), Potential (9), Affair (14), Broke Up (3), No Hurt Feeling (1), Disappointed (2), Agony (1), Broken Heart (3), Hurt Feeling (3) and Lost Feeling (3). By using RFM analysis, it can effectively creating a marketing strategy to increase the status of potential customer to the loyal customer to increase the corporate’s revenue and to improve corporate’s value added.

Abstract 4119072: When is the Broken Heart Most Dangerous? Assessing Risk Factors to Predicting Mortality in Takotsubo Cardiomyopathy: Analysis of The National Inpatient Sample 2021

Introduction: Takotsubo Cardiomyopathy often presents very similarly to acute coronary syndromes (ACS). Although the gravity of the condition is being increasingly recognized, prognostic factors have been hardly established. We applied known near-term ACS mortality risk factors to determine their prognostic value in takotsubo cardiomyopathy. Methods: We analyzed the National Inpatient Sample database for 2021. Inclusion criteria were Principal Diagnosis of Takotsubo Syndrome (ICD 10 code "I5181") and age 18 years or more. Different comorbidities, age, and gender were analyzed in these patients, and the primary outcome was inpatient mortality. Univariate logistic regression was used to test the association of each factor with mortality, and multivariate logistic regression was then used to test for independent predictive value. Analyses were performed using STATA/BE 18.0. Significance was set at 0.05. Results: 9109 admissions for takotsubo syndrome were identified (10.3% males and 89.7% females) with a mean age of 67 years and an inpatient mortality rate of 2.31%. On univariate regression, age (OR 1.04; p=0.013), heart failure (OR 3.2; p&lt;0.001), atrial fibrillation (OR 3.12; p&lt;0.001) and chronic kidney disease (OR 3.54; p&lt;0.001) were significant predictors of mortality while gender(0.389), diabetes(0.132), hypertension (0.052), smoking (0.617), nicotine dependence (0.075), hypercholesterolemia (0.686), obesity (0.728), history of stroke (0.068) and history of myocardial infarction (0.613) were not significantly associated with mortality. On multivariate regression, only heart failure (OR 2.8; p=0.007) and chronic kidney disease (OR 2.34; p=0.032) were independently associated with inpatient mortality. Conclusion: Our findings are mostly congruent with the existing literature regarding this condition. Pre-existing heart failure and a history of chronic kidney disease are poor prognostic factors in patients presenting with Takotsubo cardiomyopathy. Further large-scale studies are required to validate our findings.

Syndrome of a truly broken heart: the first report of left ventricular rupture in a patient with recurrent takotsubo syndrome

Syndrome of a truly broken heart: the first report of left ventricular rupture in a patient with recurrent takotsubo syndrome

A Syndrom of Takotsubo Cardiomyopathy Induced by Acute Stress: A Case Study of Broken Heart Report

A Syndrom of Takotsubo Cardiomyopathy Induced by Acute Stress: A Case Study of Broken Heart Report

6668 Myxedema Coma and Takotsubo Cardiomyopathy

Abstract Disclosure: A.M. Skariah: None. S. Jain: None. Background: Takotsubo cardiomyopathy (TCM) also know as broken heart syndrome is a transient decrease in systolic cardiac function in the absence of obstructive CAD. TCM is likely related to hyperadrenergic conditions leading to increased cardiac sensitivity to catecholamine surge leading to cardiomyopathy. TCM is more associated with hyperthyroidism. Case presentation: Patient is an 84-year-old female with PMH of celiac disease,hypertension,prediabetes, and atrial fibrillation s/p cardioversion, on amiodarone. She was brought to the ER after having an unwitnessed fall. She was hypotensive 76/56 mm of Hg, hypothermic 35.5 degree C, HR 90 beats/min; labs significant for hyponatremia, macrocytic anemia, TSH 65.47uIU/ml, FT4 &amp;lt;0.4 ng/dl and mild QTC prolongation of 469ms. Family mentioned history of constipation, progressive weakness, poor oral intake, memory problems and cold sensitivity for a couple of months. Started on 1 pressor, 3 units of PRBC and 2 liters of IVF; BP improved; labs and history suggestive of myxedema coma with myxedema coma Popoveniuc score 85 suggestive of high suspicion for myxedema coma.She had TSH 50.39 uIU/ml and FT4 of 0.4 ng/dl for her memory issues workup 2 months prior to presentation but was not started on medication. Upon admission, started stress dose steroids followed by IV levothyroxine 100 mcg. Not started on LT3 given her old age and atrial fibrillation history. Received additional dose of LT4 100 mcg within few hours. TFT improved with TSH 35 uIU/ml and FT4 1 ng/dl after 2 doses. Later same day, shock worsened, and patient was on 3 pressors along with stress dose of steroids. Cardiology was consulted; recommended an Echocardiogram.Echo was done on day 2; EF 55-60 % with severe hypokinesis of apical myocardium consistent with TCM. Normal echocardiogram studies 4 months ago.Started on weight-based regimen of LT4 75 mcg IV on day 3 and switched to 100 mcg oral when patient tolerated pills.Patient was down to 2 pressors on day 3 and gradually off pressors by day 6. Repeat TFT -showed improvement TSH 12 uIU/ml and FT4 0.7 ng/dl—day 5. Eventually her mentation improved and was discharged on oral LT4. Conclusion: TCM is rare complication of treatment of myxedema coma. Our patient developed shock requiring 1 pressor which unexpectedly worsened to 3 pressors requirement after initial LT4 treatment. High doses of LT4 and LT3 which is part of myxedema coma treatment sensitizes myocardial tissue to catecholamines by increasing expression of beta adrenoreceptors in cardiac myocytes with subsequent ionotropic and chronotropic effects. This may contribute to cardiac stunning and TCM. It’s beneficial to evaluate patients with myxedema coma who develop worsening cardiac status after initiation of high dose of thyroid hormone replacement for TCM. Presentation: 6/2/2024

Poe-life: emphatic technology in sanative writing application as a way of assisting underachieving students

ABSTRACT Performance issues can lead to frustration and feelings of helplessness. When designed emphatically, technology can understand emotionally-born human communicators in channeling worries. Poe-Life, a poetry writing application, uses emphatic technology to offer an alternative instrument for creative writing. Non-regular students, those with GPA under 2.0 and study time over 4 years, can benefit from this application. The study aims to prove how creative poetry writing helps non-regular students deal with performance issues and how emphatically technologized writing application enhances writing process. Three non-regular Binus English Department students' poems were chosen, i.e. Try (by RYP), someday (RIM), and Broken Heart (ZMT) to reveal students' implicit oppressions. The study found that sanative poetry writing helps non-regular students express their performance problems through metaphors. Students' problems stem from lack of self-confidence, low self-esteem, and anxiety. Poe-Life app is preferred due to its friendly, emphatic features and word assistance. Emphatic technology can enhance creative writing process.

A Narrative Review on Broken Heart Syndrome: A Guide for Clinicians to Understand Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy (TCM) is a transient and reversible cardiomyopathy which exhibits regional wall motion abnormalities in the absence of obstructive coronary artery disease. While TCM is a rare condition (incidence &lt;1%), its diagnosis has increased since its initial description in 1990. While many cases may follow an acute physical or emotional stressor, pathophysiology is likely multifactorial including factors such as catecholamine surges and microvascular dysfunction. On initial presentation, TCM often mimics acute coronary syndrome but may be differentiated with coronary angiography. Additional laboratory testing and imaging including transthoracic echocardiography may help with diagnosis and identification of complications such as left ventricular (LV) outflow obstruction and LV thrombus. Treatment is supportive, although medications such as angiotensin-converting enzyme inhibitors and beta-blockers have shown some benefit in improving long-term outcomes. Acute complications may include arrhythmia, LV or systemic thrombus, and cardiogenic shock, but most patients do well and experience rapid recovery. TCM continues to be an active area of research as there is still much to be learned regarding its pathogenesis, diagnosis, and treatment. This review analyzes the latest research to provide insight into the presentation, pathophysiology, diagnosis, and management of TCM.

A Case of Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy (TCM), also called stress cardiomyopathy, broken heart syndrome and apical ballooning syndrome, is a heart problem that occurs after intense stress, sadness or shock. Takotsubo cardiomyopathy usually presents with chest pain and dyspnoea and is similar to the diagnosis of acute coronary syndrome. Echocardiography and coronary angiography have an important role in the diagnosis of Takotsubo cardiomyopathy. In this case report, we wanted to investigate Takotsubo cardiomyopathy in a 59-year-old woman who presented to the emergency department.

Doctors for Global Health Statement on Gaza

We, Doctors for Global Health, write with a broken heart, this letter to publicly condemn the horrific atrocities ongoing in Gaza, which the United Nations (UN) Special Rapporteur has stated that there are “reasonable grounds” to declare a genocide