By: CHRISTINE GORMAN
I HAD ALWAYS ASSUMED THAT A BROKEN HEART was just a metaphor, a cliché of country music and romance novels. So I was as very surprised as anyone to learn last week that doctors now consider it a real medical event, one that can kill.
The news comes from a report published in no less than the New England Journal of Medicine, in which physicians at Johns Hopkins described a group of 18 mostly older women and one man who developed serious heart problems after experienc-ing a sudden emotional shock, such as the death of a loved one, or, in the case of one 60-year-old woman, a surprise birthday party.
What truly surprised the doctors who examined these patients was that none of them had actually suffered a heart attack. Indeed, few had any signs of heart disease at all. Yet at least five of the 19—and perhaps more—would have died without immediate treatment, according to Dr. Ilan Wittstein, the cardiologist who led the study. What was going on?
To get to the bottom of it, Wittstein and his colleagues measured the levels of cate-cholamines—the family of stress hormones that includes adrenalin—that their pat-ients were producing. In each case they found high levels of stress hormones—up to 34 times as great as normal levels and two to three times as great as those typically seen during severe heart attacks.
It’s still unclear whether the hormones caused the cardiac problems or were caused by them. Nor can doctors explain why women’s hearts seem more vulnerable than men’s. “Men typically produce higher levels of catecholamines in response to a stressful event than women do:’ Wittstein says. “So if you had to guess, you’d have to guess that men would have this problem more than women.
The good news about the condition doctors are calling the broken-heart syndrome
is that it’s reversible—provided the initial shock isn’t too great and doesn’t kill you. And repeat occurrences appear to be uncommon, no matter how many surprise
birthday parties they throw you.
CAN FOOD LIFT YOUR SPIRITS?
A diet rich in omega~3 fatty acids and undine can—at least in rats. These mood molecules are found in fish, walnuts and molasses and are as effective as drugs in treating depression in rodents. People too, probably: fish-eating cultures tend to have lower rates of depression.
NOT AS BRAIN DEAD AS THEY SEEM
Researchers using MRI brain scans found that some seriously brain-damaged—but not comatose—patients responded to a loved one’s voice in patterns of neural activity similar to those of healthy subjects. Such scans may play a key role in future decisions over care for the unconscious. Go ahead - - talk to them normally.
TEENAGE DEPRESSION SHOWS FAMILY TIES
Children and teenagers sometimes experience bouts of helplessness, hopelessness, and despair that are diagnosed as major depression. Researchers have been unable to determine whether depressed youths display an early version of adult depression or a different mood disorder, perhaps stemming from problems such as anxiety, delinquency, and substance abuse.
There does appear to be a strong family connection, however. A new investigation has found that adult depression and the teenage version run in the same families.
In interviews with students at nine high schools in western Oregon, psychologist Peter M. Lewinsohn and his colleagues at the Oregon Research Institute in Eugene identified 268 students who had previously experienced episodes of major depression (usually starting at age 13 or 14), 110 who had suffered from anxiety dis-orders or other psychiatric problems that didn’t include depression, and 291 who had never developed any mental disorders. The researchers then interviewed 2,202 of the participants’ parents and siblings age 13 or older.
Compared with the study group without mental disorders, family members of de-pressed adolescents show markedly elevated rates of major depression and moder-ately elevated rates of alcohol abuse, according to the team’s study, which appears in the January ARCHIVES OF GENERAL PSYCHIATRY. Most family mem bers who abused alcohol also exhibited depression.
However, parents and siblings of depression-free teens with anxiety disorders, such as panic attacks, or drug abuse show no increased depression rates, reports Lewinsohn’s group.
These findings strengthen earlier reports suggesting that adolescent depression exists apart from other emotional disorders, often as a prelude to adult depression, comments psychiatrist Richard Harrington of Royal Manchester Children’s Hospital in England. Uncovering the specific ways in which genetic and environmental factors promote depression in certain families will require further study, he says. —BB.
PEOPLE ON THE GO FOLLOW THE FLOW
It’s easy to walk from the living room to the hallway, the hallway to the bathroom, and so on. Yet scientists have long argued about how people navigate to a dest-ination.
A virtual reality device that allows individuals to walk through a world in which the laws of optics systematically go awry may help settle this debate, a team of cognitive scientists reports in the February NATURE NEUROSCIENCE.
It’s possible that a person moving toward a target aligns it within the tunnel-like rush of visual stimuli, known as optic flow, that bombards the eyes. In contrast, observers may gauge the direction of a target relative to their own body by centering the target in their line of sight and then moving forward.
Or the visual system employs both of these tactics, depending on how much optic flow is provided by one’s surroundings, contend William H. Warren of Brown University in Providence, R.I., and his coworkers in their report.
In their study, 10 volunteers wore head-mounted devices that enabled them to walk through virtual environments in which optic flow was distorted so that the person veered slightly to one side. In sparse settings that produced little optic flow, volunteers ended up walking a curved path to their destination. Each observer used the minimal flow information to walk forward a few feet. He or she then stopped, turned toward the virtually displaced destination, and again moved forward. Each person repeated this process several times.
In environments with features such as textured floors that provided lots of optic flow, volunteers walked straighter, more accurate paths toward targets. They continuously monitored optic flow and used feedback from it to readjust their heading, often adopting a slightly sideways gait, the researchers say.
A STICKY PROBLEM SOLVED
A small cut won’t bleed for long because tiny blood cells called platelets stick together and trigger clots. Damaged blood vessels and red blood cells release a compound known as adenosine diphosphate, or APP, which triggers the process that makes platelets sticky.
Sometimes, however, overly reactive platelets are attracted to arteries damaged by fatty buildup. There, they form clots that, if dislodged, can sweep into the heart or brain, where they sometimes cause heart attacks or strokes.
Researchers know that two drugs—clopidogrel and ticlopidine—that are used to reduce the risk of heart attack and stroke work by blocking an APP receptor found on the surface of platelets. However, analyzing the receptor itself has been a sticky problem, says Pamela B. Conley of COR Therapeutics in San Francisco. Researchers want to learn the sequence of amino acids in that protein.
“Knowing the... sequence will allow us to design better inhibitors for this receptor [and thus better drugs]”, Conley says. Clopidogrel and ticlopidine are relatively slow-acting because they must be broken down by the liver before they inhibit clotting.
To frog eggs, Conley and her colleagues added a mixture of genetic material isolated from rat platelets. They’d already engineered the eggs, which don’t normally have an APP receptor, to produce an electrical signal when the APP receptor is present and binds to APR Cells that received the rat APP-receptor gene produced a detectable electric current, while cells getting other genes did not. Using electrical signals as their cue, the researchers isolated the rat APP-receptor gene, they report in the Jan. 11 NATURE.
All in all, they make a convincing case that they have indeed identified this biologically and clinically important molecule” says Skip Brass of the University of Pennsylvania in Philadelphia in an accompanying editorial.
SUCCESS CLEARING CLOGGED ARTERIES
ANGIOPLASTIES—procedures to open blocked arteries—have been successful about 10 percent more often in recent years than they were in the mid-1980s, and patients treated a few years ago were about 40 percent less likely to need later angio -plasty or surgery than were patients a dozen years earlier.
Using national registries, Pavid 0. Williams of Brown University in Providence, RI., and his colleagues compared records for 1,559 people who underwent angioplasty in 1997 or 1998 with the outcomes of 2,431 people getting similar treatment in 1985 or 1986. Angioplasty, in which a surgeon threads a small balloon through a person’s arteries and then inflates it, was the only procedure used on the 1985— 1986 patients. It successfully opened the blocked arteries 82 percent of the time.
By 1997, cardiologists were regularly inserting mesh tubes called stents into their patients’ arteries to hold them open after angioplasty. They less frequently used other techniques, such as atherectomy, a procedure to scrape away excess fat. In 92 percent of the 1997—1998 cases, the procedures successfully opened blocked arteries.
Within a year after their initial angioplasty, almost 13 percent of the people treated in 1985 or 1986 developed further artery blockage and underwent heart-bypass surgery, compared with about 7 percent of those in the 1997—1998 group, the researchers report in the Dec. 12, 2000 CIRCULATION.
Doctors added stents to angioplasty in about 64 percent of the 1997—1998 treatment group. They used atherectomy along with angioplasty and stents in 6 percent of patients and atherectomy with angioplasty but no stents in another 3 percent. “Patients were older and sicker [in the 1990s group]... and in spite of that, they had better results,” says Williams. Stents, he says, can probably take most of the credit.
February 3, 2001 (pg. 72)
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