Real Patients, Real Stories: Regulating a Racing Heart

Brittany Martin, a children’s dance coach, experienced constant adrenaline over the course of a year, leading her to visit Emory University Hospital. “My body was in fight or flight mode all the time,” she says.

Martin began seeing a doctor in Mcdonough in 2015 for an elevated heart rate. She attributed her heart racing to stress from her dance team at the Platinum Peaches studio in Decatur, Georgia. She was preparing for a competition.

Then, one Monday last summer, she felt worse. She became more concerned about the increased headaches, chest pain, and heart palpitations. Her husband drove her to the emergency room, where doctors ran tests to determine if she was experiencing a heart attack. The doctors performed an electrocardiogram and looked for troponin her blood, a sign of damage to the heart muscle. The results showed that everything looked fine. Martin was sent to have a head CT scan. The severity of her headaches was brutal to the point where she was screaming and kicking. After an extra troponin test was in the suspicious range, she was sent to the cardiac catheterization lab thinking “I’m 30 years old. Why am I having a heart cath?”

The doctors did not see any blockages that would cause problems. However, an ultrasound exam of her heart showed that walls of the base were not moving. She had an ejection fraction (a measure of the heart’s pumping efficiency) of 30 percent, similar to those who have heart failure. Stam Lerakis, Director of Interventional Echo and Cardiac MRI at Emory University Hospital, said this indicated a rare condition called Takotsubo cardiomyopathy. This is known as stress-induced cardiomyopathy or “broken heart syndrome” and can occur mainly in post-menopausal women.

“We do see this regularly,” says Lerakis, who recalled seeing a case in which a man had a stroke and his wife, because of her distress, developed the syndrome. Martin appeared to have the reverse form, where the apex still contracted. This is more common among younger women possibly because of age-related changes in how the heart responds to epinephrine. Martin was then sent for a cardiac MRI to solidify the diagnosis.

“The catheterization results did not explain the weakness of the heart. We needed to determine if there was a problem with the heart walls and see if the muscle was still alive. That’s how we found the tumor,” says Lerakis.

The mass, about a size of a quarter, was found near Martin’s spine. Based on Martin’s symptoms, the doctors suspected it was a paraganglioma, a tumor that produces epinephrine and norepinephrine. Her blood and urine showed high levels of metabolic products of epinephrine and norepinephrine also known as catecholamines. “In Takotsubo, the heart is essentially stunned, but we expect that it will be able to recover,”  Lerakis says. “He heart was bombarded by catecholamines.”

Martin was prepared for surgery. She was given alpha and beta blocker drugs to counteract the effects of the catecholamines. This restored her heart to normal pumping efficiency but she was not out of danger yet. “Any manipulation of the tumor could cause a sudden release of catecholamine, leading to severe increases in heart rate and blood pressure,” says Seth Force, the thoracic surgeon who removed her tumor. “That’s why the blood pressure and heart rate have to be controlled by medicines prior to surgery – to avoid any cardiac issues.”

Genetic tests revealed that Martin has a mutation that increases the risk of developing paraganglioma. One of her daughters has the mutation as well; both will have to get periodic scans. As for now, she is planning more dance competitions. “I’m doing great,” she says. “My relatives can’t believe that I was in the hospital last year.”

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