THE chest pain began just as Carmen Spindler emerged from church after her father-in-law's funeral service, and it lasted during the drive to the cemetery. At first Mrs. Spindler thought it was nothing to worry about, just a case of nerves.
Recovering: Dr. Hunter Champion, left, and Dr. Ilan S. Wittstein with Kathleen Heilman of Westminster, Md., a patient at Johns Hopkins Hospital who has had three broken-heart syndrome episodes.
But when the pain did not let up, and she began feeling weak and shaky, her family insisted on calling an ambulance.
At the hospital, doctors said they suspected a blockage in one of the coronary arteries, which feed blood to the heart. A narrowed vessel could produce chest pain; a complete blockage could cause a heart attack. Mrs. Spindler, who lives in Baltimore, was transferred to Johns Hopkins Hospital for an angiogram, a test in which dye is injected and X-rays taken to look for clogged blood vessels.
She got good news: her coronary arteries were clear. There was no sign of a heart attack. But other test results were disturbing. Her heart was dangerously weak, pumping only a fraction of the normal amount of blood. About half the muscle in the main pumping chamber, the left ventricle, was simply not working.
"We didn't know what to think," Mrs. Spindler said of the episode, which happened several years ago. "It was very unnerving and scary. My husband was extremely upset."
Dr. Ilan S. Wittstein, a cardiologist at Johns Hopkins, told Mrs. Spindler that he suspected she was suffering from a condition that he and his colleagues had nicknamed broken-heart syndrome, in which sudden emotional or physical stress can cause heart failure. In her case, he said, the upset from the funeral had probably caused a burst of the stress hormone adrenaline, and the level had spiked high enough to become toxic to her heart and had "stunned" it, leaving it temporarily unable to contract. He predicted - correctly, it turned out - that her heart would begin to recover within a few days, with no permanent damage.
The syndrome first came to public attention in February with articles published in two medical journals.
In the last few months, Dr. Wittstein said, "I've heard from people all over the place. The majority are not the full-blown syndrome we described, but certainly a percentage of them clearly are."
His team's technical name for the condition is stress cardiomyopathy. Whether the cause of the stress is physical or emotional, the common element seems to be the flood of adrenaline and related stress hormones, known as catecholamines, which can temporarily disable the heart.
For unknown reasons, most victims are women middle-age and older.
And like Mrs. Spindler, who was in her 60's when she had the episode, most sufferers are healthy, with no history of heart disease. Some develop such severe heart failure that they would almost certainly die without high-tech treatments to keep their blood circulating, but others have such mild cases that they would probably recover even without medical help.
The syndrome is not a heart attack, though it may be mistaken for one.
Dr. Wittstein said he and his colleagues first became aware of stress-induced cardiomyopathy in 1999, when they treated two or three women who arrived at the hospital with heart failure and what appeared to be a severe heart attacks. "But they had some unique clinical features that weren't typical of a normal heart attack," he said.
Their electrocardiograms developed a distinctive, "frighteningly abnormal" pattern, he said, and blood tests that were used to detect signs of a heart attack did not match the usual findings in heart attack victims. In addition, the patients had no blocked arteries or blood clots, and when doctors watched their hearts beat on a test called a ventriculogram, they saw "an incredibly unusual pattern of contraction for any heart attack," Dr. Wittstein said. The upper region of the left ventricle contracted normally, but the bottom part, or apex, seemed to be paralyzed, and ballooned instead of contracted.
The women also recovered much faster than heart attack victims would. "We realized there was something very different about these patients," Dr. Wittstein said, adding: "We went back and took detailed histories. What tied them together was that they had had something emotionally traumatic happen."
