Cardiac team helped save her from a fall that “broke” her heart
Barbara Mishkin is grateful to be recovering from an ordeal that began with a fall in November 2022. Three days before Thanksgiving, she decided to shampoo her rugs in preparation for hosting family for the holiday.
“I was rushing because I had errands to do,” said Mishkin, a retired registered nurse who lives in Forestdale. “I tripped over a cord and fell straight down using my right hand to brace myself. The fall was hard; I could feel it in my sternum when I hit the floor.”
She went to the Cape Cod Healthcare Urgent Care Center in Sandwich, where she was X-rayed, diagnosed with a fractured wrist, and sent home with a soft cast. She was referred for placement of a hard cast the next day.
While she had pain from her fractured wrist, she also noticed a worsening pain in her chest as the week progressed.
“By the following Monday, I wasn’t feeling well at all,” said Mishkin. “I was diaphoretic (sweating), shaky, feeling weak. My blood pressure was low, and my heart rate was high. I was also feeling nauseous.”
She activated her Medic Alert when she realized her symptoms had worsened that morning.
“When Sandwich EMS arrived, I was still conscious and coherent so that I could give them my medical history, including a history of cardiomyopathy,” she said. “I was taken to Falmouth Hospital, my ER of choice since I live in Sandwich.”
The Falmouth ER team included Kenneth Spector, MD, PhD, FACC, a Falmouth Hospital cardiologist, and Chris M. Olson, Jr., MD, PhD, an emergency medicine physician.
She had an echocardiogram, electrocardiogram, chest CT scan, and bloodwork.
“Dr. Spector was amazing, such a gentleman, and explained everything that was happening every step of the way,” said Mishkin.
She was scheduled for transport to Cape Cod Hospital the following day for a cardiac catheterization procedure that would take pictures of her arteries to check for blockages.
The catheterization found that Mishkin was not having a heart attack, but instead had a condition known as broken heart syndrome.
Broken heart syndrome mimics a heart attack in several different ways and has a number of names,” said David Leeman, MD, a Cape Cod Hospital interventional cardiologist. “It is called broken heart syndrome, stress-induced cardiomyopathy, and Takotsubo cardiomyopathy.”
Broken heart syndrome has many of the signs and symptoms of a heart attack because the cardiac enzymes are elevated, and the electrocardiogram (EKG) can often be abnormal and imitate changes seen in a heart attack, he said. Chest pain can be the same as what is experienced with a heart attack.
“The final diagnosis often needs to be confirmed by taking pictures of the arteries with a heart catheterization, making sure there are no cholesterol blockages,” said Dr. Leeman. “A blocked artery indicates a heart attack.”
The catheterization showed that Mishkin did not have a blockage, which she said was “very reassuring.”
Seriousness Runs the Gamut
Dr. Leeman cautions that while patients are relieved to know that they didn’t have a heart attack, broken heart syndrome/stress-induced cardiomyopathy can also be a serious situation.
“It can run the spectrum of being fairly mild to something that can be life-threatening and even fatal,” Dr. Leeman said. “Most of the time, patients recover within the first few days, and the heart usually recovers almost completely over the next few weeks.”
The real cause of broken heart syndrome is unknown. The leading theory is that some catecholamine excess, an adrenaline-type hormone, acts on the heart. It affects the main pumping chamber of the left ventricle, and the heart does not squeeze as vigorously as it should.
“This syndrome is more common in older, post-menopausal women subjected to some kind of stress,” he said. “They’ve lost a spouse or someone close to them. They may have suffered emotional trauma. The stress can also be physical, resulting from a fall, fracture, pneumonia, or another physical injury. Sometimes, we don’t identify a stress trigger at all.”
The incidence of this syndrome has soared over the past 20-30 years, according to Dr. Leeman. It was first identified in 1990 in Japan. Researchers named it Takotsubo cardiomyopathy because the images of the ballooning left ventricle pumping chamber resembled the appearance of an octopus trap.
Mishkin continues to recover at home and is doing well. As fearful as she was, especially facing a cardiac catheterization, she said the cardiac team allayed her fears.
“Everything went smoothly, and Dr. Leeman kept me in the loop every step of the way. The nursing care was phenomenal, and they made me feel comfortable despite all the technology,” she said. “I’ve worked in Harvard teaching hospitals and medical centers, and I was a bit skeptical locally, but I would recommend the cardiac teams at both hospitals; they were great.”
Mishkin said in addition to Dr. Leeman, she would specifically like to thank Drs. Spector and Olson, Emily (ER nurse), Amy (RN, 4th floor) at Falmouth Hospital, as well as the rest of the Cape Cod Hospital cardiac team: Leah Pacheco (PA); Sharon (RN); and the nurses on North 3.
