The Bismarck Tribune from Bismarck, North Dakota • A4

A4 Saturday, February 9, 2019 Bismarck TriBune 1 HEALTH ROBERT H. SHMERLING, M.D. Tribune Content Agency My friend swears that changes in the weather cause her joints to ache more than usual. Is this real or just a myth? The belief that weather af- fects aches and pains in the joints is longstanding. But there is no convincing science to back that up.

The question of whether a link between weather and aches and pains has been studied extensively. While a definitive answer is nearly impossible to provide because hard to a (prove that something exist) researchers have been unable to make a strong case for a strong connection. A recent study finds no con- nection between rainy weather and symptoms of back or joint pain. This conclusion was based on a staggering amount of data: more than 11 million medical visits oc- curring on more than two million rainy days and nine million dry days. Not only was there no clear pattern linking rainy days and more aches and pains, but there were slightly more visits on dry days.

An earlier Australian study found no link between back pain and rain, temperature, humidity or air pressure. This study col- lected data regarding features of the weather at the time of first symptoms, and compared it to the weather a week and a month before. But, a different study found that among 200 patients followed for three months, knee pain increased modestly when temperature fell or barometric pressure rose. worth remembering that humans have a remarkable ten- dency to remember when two things occur or change together (such as wet, gloomy weather and joint pain), but remember less when things do not occur together. That rainy day when you felt the same as you usually do is un- likely to be so notable that you remember it.

If you rely solely on memory rather than on more rigorous, data-based evidence, easy to conclude a link exists where, in fact, none does. When my patients tell me they can predict the weather by how their joints feel, I believe them. hard to discount it when so many people notice a connection. They could represent an excep- tion to what the studies show. But I also believe the science.

Until I see evidence even more compelling, I remain a skeptic about the weather and arthritis connection. robert H. Shmerling, M.d., is associate professor of Medicine at Harvard Medical School and clinical chief of rheumatology at beth Israel deaconess Medical Center in boston. For additional consumer health information, please visit www. health.harvard.edu.

Does weather affect joints? Stress cardiomyopathy, sometimes called heart a reversible condition which often mimics a heart attack is being recognized with increasing frequency NOT FOR THE FAINT OF HEART HARVARD HEALTH LETTER he term usually con- jures up the sad ending of a love af- fair. In fact, the death of a spouse is a commonly cited trigger for bro- ken-heart syndrome a temporary weaken- ing of the heart that causes symptoms similar to a heart attack. Also known as stress cardio- myopathy, the condition usually results from severe physical or emotional stress, though sometimes there is no identifiable trigger. Al- though rare, now being recognized much more often than in the past. cardiomyopathy was not on any- radar screen 25 years said Patrick a cardiologist at Harvard-affiliated Brigham and Hospital.

Japanese doctors who first described the condition in the early 1990s called it takotsubo car- diomyopathy. Why? During an episode, the heart takes on an unusual shape that resem- bles a tako-tsubo (octopus pot), a tradi- tional clay vessel a fisherman uses to trap an octopus. Exactly why the heart muscle takes on that shape exactly clear. But the cur- rent thinking is that the triggering event releases an outpouring of stress hormones such as adrenaline, said. The surge of hormones seems to stun the heart.

The tip of the left ventricle (the main pumping chamber) balloons outward, while the base draws inward. As a result, the walls of the left ventricle contract effec- tively. The workload increases, lead- ing to symptoms such as chest pain and breathlessness. Mending a broken heart? Most of the time, people with stress cardiomyopathy recover fully within a month, said. However, just as with a serious heart attack, people may need to be hospitalized for several days and may have major complications.

There any specific treatment guidelines, but doctors often prescribe beta blockers and ACE inhibitors, which may help the weak heart mus- cle recover. Broken-heart syndrome usually recur, but anyone who experiences it once should be attuned to how he or she may react to stressful events in the future, cautions Possible triggers Occasionally, the reported trigger for stress cardiomyopathy stems from a happy event, such as a wedding or a surprise party. but the most common triggers are physical stresses or sad or negative events. For example: a severe illness, such as an infection Major surgery an episode of a neurological or psychiatric disorder an argument the death of a relative (especially if unex- pected) a devastating financial or gambling loss a natural disaster (an earthquake or flood) The brain-heart link The most common triggers are physical, such as major surgery or a severe illness due to an infection, for example. However, talking with patients about possible triggers and how emotions can affect the heart also provides clues.

condition reconfirms the relationship between the brain and the said. However, stress cardiomyopathy occasionally results from medications given in a hospital, such as those used to support the circulation, he adds. For unknown reasons, broken-heart syndrome is less common in men; about of cases occur in older women. One reason may be differences in the number and distribution of nerves in hearts compared with those of men. Hormonal factors may also play a role.

The emotional triggers of stress cardiomyopathy are usually negative, such as grief, conflict, or anxiety. But in rare cases, happy events can also cause stress cardiomyopathy. Diagnosing the problem Because the symptoms are so similar to those of a heart attack, doctors start the diagnostic evaluation with an electrocardiogram (ECG), a test that records the electrical activity. The ECG may show abnormalities typical of heart muscle injury, which can occur from both a heart attack or stress cardiomyopathy. Both conditions can also cause a rise in blood levels of troponin, a protein released from damaged heart muscle, although the rise may be less pronounced in stress cardiomyopathy.

Doctors also rely on a heart ultrasound (echocardiogram) to reveal movement abnor- malities in the walls of the left ventricle and the characteristic takotsubo shape. More in- vasive testing is often needed as well to rule out a more typical heart attack. Symptoms While the causes of the conditions are different, symptoms of stress cardiomyopathy are often similar to those of a heart attack: Chest pain Shortness of breath Sweating dizziness Weakness Nausea and vomiting Palpitations (the sensation of the heart pounding) Recurrence research shows that 5 to 10 percent of patients experience a recurrence of stress cardiomyopa- thy, even if subsequent stressful events occur in a life. THE MEDICINE CABINET HARVARD HEALTH LETTER Sources: Harvard Health, Johns Hopkins Medicine DREAMSTIME Breaking down broken heart syndrome A study of 1,750 patients with takotsubo, or stress, cardiomyopathy from 1998 to 2014, drew the following conclusions: Lee Enterprises graphics 5.9% Median age at diagnosis: 66.8 Sex and age Triggers Fatalities Emotional trigger The study reported a 5.9% mortality rate 30 days after diagnosis. Physical trigger Physical and emotional triggers No evident trigger 27.7% 7.8% 28.5% 89.8% women 10.2% men Source: New England Journal of Medicine.