You may have heard of people suffering from a broken Heart, but Takotsubo syndrome (TTS) or “Broken heart syndrome” is a very real condition. However, new research shows that happiness can break your heart too. TTS is characterised by a sudden temporary weakening of the heart muscles that cause the left ventricle of the heart to balloon out at the bottom while the neck remains narrow, creating a shape resembling a Japanese octopus trap, from which it gets its name.
Since this relatively rare condition was first described in 1990, evidence has suggested that it is typically triggered by episodes of severe emotional distress, such as grief, anger, or fear. Symptoms of Takotsubo syndrome can mimic those of heart attack. In both conditions, people can experience sudden onset of chest pain and/or shortness of breath. Laboratory findings such as troponin (a protein released from heart muscle cells) can be elevated in both conditions as well. Additionally, ECG characteristics, which provide more details on electrical pathways in the heart, can also be very similar between TTS and heart attack patients. Therefore, telling the conditions apart is very challenging. Much more than just an expression, this is a serious condition which can lead to rapid heart failure and even death. Unlike heart attacks, where angiography (a catheter is used to assess patency of coronary arteries) will reveal blocked arteries, TTS patients have normal blood flow in their coronary arteries. Therefore, stents (metallic devices to keep the artery open) are not the mainstay of therapy, unlike patients with heart attack. The treatment for TTS patients is supportive care and majority of patients with this condition will recover their heart function in weeks to months.
To date, there have been no studies linking positive emotional experiences to heart failure of this kind. However, new research suggests that happy events can also trigger the same condition. Systematically analysed data from the International Takotsubo Registry (the largest registry of patients diagnosed with TTS worldwide) found that 485 of the 1,750 registered patients had a definite emotional trigger. The exact mechanism of involved in processing intense emotions and subsequently their effect on heart function is not known. Nonetheless, we postulate the neurohormonal pathways activated in the brain by emotions can play a key role. Of the patients in our study, 20 (4%) had TTS that had followed happy and joyful events such as a birthday party, wedding, surprise farewell celebration, a favourite rugby team winning a game, or the birth of a grandchild; 465 (96%) had occurred after sad and stressful events, such as death of a spouse, child or parent, attending a funeral, an accident, worry about illness, or relationship problems and one occurred after an obese patient got stuck in the bath.
Interestingly, 95% of the patients were women in both the “broken hearts” and “happy hearts” groups, and the average age of patients was 65 among the “broken hearts” and 71 among the “happy hearts,” confirming that the majority of TTS cases occur in post-menopausal women.
These new findings should lead to a paradigm shift in clinical practice as they show that the triggers for TTS can be more varied than previously thought. A patient suffering from TTS is no longer the classic “broken hearted” patient, and the disease can be triggered by positive emotions too. Clinicians should be aware of this and also consider that patients who arrive in the emergency department with signs of heart attacks, such as chest pain and/or breathlessness, even after a happy event or emotion, could be suffering from TTS just as much as a patient presenting after a negative emotional event. The findings broaden the clinical spectrum of TTS and suggest that happy and sad life events may share similar emotional pathways that can ultimately cause TTS.
Perhaps extremes of the human emotional range, both positive and negative, are more closely related in impacting the cardiovascular system that previously thought. Understanding the pathways between the brain and the heart is not only fascinating as they unravel the pathophysiology of this particular syndrome, but also allows development of unique and innovative therapeutic ways to treat cardiovascular disease.
Featured image: Smile by Giuliamar. CC0 Public Domain via Pixabay.
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