June 22, 2006 — -- This report was originally broadcast May 12, 2006.
In "Grey's Anatomy," a woman is admitted to the hospital every year, on the anniversary of a traumatic event in her life, suffering the classic symptoms of a heart attack. But it's not a heart attack. It's a medical mystery -- part of a plot twist in the show. But the fictional case is based on a nonfictional problem, and Joyce Fagan had it.
Fagan went to the hospital with heart attack symptoms on the eve of her son's wedding. "It was physical pain, it wasn't just my heart feeling sad. It was as if someone had kicked me in the chest," she said.
"Certainly, the symptoms are the same symptoms that people have when they're having a heart attack. Shortness of breath, chest pain," said Dr. Hunter Champion, a Johns Hopkins cardiologist.
But what's going on in these patients is quite different from what happens during an actual heart attack.
What caused Joyce Fagan's pain after her son's wedding rehearsal dinner was the news that her brother had died suddenly of heart failure.
"I just couldn't believe, because he had been to the rehearsal dinner ... and I became hysterical," Fagan told "20/20."
Doctors at Johns Hopkins discovered that despite her symptoms, her coronary arteries were clear. Her symptoms fit a pattern that Champion and another prominent cardiologist, Dr. Ilan Wittstein, had identified in their research. They were investigating why some emergency patients had been diagnosed with heart attacks -- although they didn't have the heart damage.
"We started seeing things that just were quite different from what you see with a heart attack. The blood work didn't add up. The electrocardiogram looked a bit different. The actual shape of the heart muscle was quite unique, different from what you see with a heart attack. These patients didn't have any blockages in their coronary arteries. There was no blood flow limitation to the heart," Wittstein said.
"At that point we started thinking about the role of stress," Champion said. "They all had very interesting stories to that effect. And we thought about the role of stress and stress hormones, like adrenaline, causing this response."
Wittstein and Champion discovered that extreme stress -- either emotional or physical -- can release enough adrenaline to literally stun the heart into mimicking the symptoms of a heart attack. That's what happened to Joyce Fagan when she heard the news of her brother's death.
"They were able to show me on the screen the blood not pumping through. It was just sort of swishing back and forth in there," Fagan said.
"We use the term 'stunned,' which means that the heart cell isn't contracting normally, but it's not a dead cell," Wittstein said. "In a true heart attack, cells die. And those cells tend to not recover once they die. In the broken heart syndrome, there's stunning of the heart muscle from this adrenaline, which means that within a few days or weeks, those cells will be working again, and that obviously has major implications as to how someone's going to do in the long run."
Often referred to as "Broken Heart Syndrome," the condition is known technically as stress cardiomyopathy, and the doctors' findings about the syndrome were published last year in the New England Journal of Medicine. Its causes -- identified in a variety of patients and circumstances in the study -- are rooted in the emotions.
"Grief, severe grief, the death of a loved one, is the most common ... and that's why we actually started using the nickname 'broken heart syndrome,' because a lot of the patients had come in after a loved one had died. We've seen severe anger. People who are in domestic disputes, where police have been called. So really it runs the gamut of emotions," Wittstein said.
He emphasized the importance of paying attention to these symptoms, saying, "I think if you are sick enough with the syndrome, it can actually be fatal."
He believes that about one in three people who have this condition would die if they didn't receive medical care.
If it surprises you that doctors seem to have lagged several centuries behind poets in acknowledging the damage a broken heart can do, Wittstein said new technology such as ultrasound is what allowed medicine to catch up.
Doctors at Hopkins now question patients to determine whether the timing of an apparent heart attack is associated with a stressful incident.
Karen Schillings suffered from the syndrome after her daughter died in a boating accident in March 2004.
She is doing well now. She and her husband, Denny Schillings, have created a scholarship foundation in their daughter's memory; and she has returned to work as an art teacher and found that it became a means of dealing with her grief. (To learn more about the foundation, visit this Web site: www.cjsfoundation.org.)
And that's an important point to stress, said Champion and Wittstein.
"In all the years that we've been following patients with this syndrome, we've never had a patient not fully recover from the standpoint of their heart muscle. In reality, the heart is not broken and goes on to fully recover," Champion said.
And that's where medicine and poetry meet: "Time," said Champion, "does mend a broken heart."