Your heart is one of the hardest working organs in the body, pumping around 2.5 billion times over the course of the average lifetime. It is also one of the most vulnerable parts of our anatomy and particularly sensitive, not only to unhealthy lifestyles but even more so to physical and emotional stress.
Broken heart syndrome, also known as ‘takotsubo cardiomyopathy’, is a medically recognised condition, where the heart literally goes into shock, to the point where it becomes ‘stunned’ and weakened. This condition is arguably the strongest mind to body reaction ever seen in medicine and, in some acute cases, can lead to death.
The condition was first described and named by Japanese cardiologists in 1990. Observing the shape of the heart during an attack, where the lower portion is paralysed whilst the upper part is still contracting, the cardiologists likened it to the shape of the pots used by local fishermen to catch octopus, called the ‘takotsubo.’
Older women at greatest risk
Broken heart syndrome can occur at any age and in both men and women. However, it overwhelmingly affects postmenopausal women, making them more susceptible to the effects of sudden stress.
According to the international registry of people with broken heart syndrome, approximately 90 per cent of people who experience the condition are women with an average age of 66. This is thought to be due to a decline in oestrogen after menopause, a hormone that plays a key part to play in keeping cardiovascular tissue healthy.
The precise cause of the condition is not fully understood but experts believe surging stress hormones essentially flood the heart, triggering changes in heart muscle cells, or coronary blood vessels, possibly both, that prevent the left ventricle from contracting effectively. This, in turn, causes the heavy, ‘achy’ feeling you get in the chest which is often mistaken for a heart attack.
Heart-brain connection
Whilst none of us can avoid stressful life events, obviously only a small number of people end up suffering a potentially life-threatening case of broken heart syndrome. This is because everyone responds differently to the psychological changes that occur in response to serious stress. Researchers have long suspected there is a brain and heart interaction that plays a role in the development of broken heart syndrome.
A small study by Swiss researchers looked at what was happening in the brains of patients with broken heart syndrome, compared to people with no history of the condition. Compared to the brains of healthy control subjects, people with broken heart syndrome had altered functions in areas of their brain that control emotions and the autonomic nervous system – responsible for heart rate and the ‘fight or flight’ response.
In broken heart syndrome patients, there was less communication between regions involved with controlling emotions and unconscious or automatic body responses, such as heartbeat and response to stress. This suggests the condition originates in the brain, where our emotions are processed, with top-down influences on the heart.
The exact pathway is still not completely understood, with more work needed, however, scientists are closer to understanding the role the brain plays in this condition and why some are more susceptible than others.
How much stress is too much?
Broken heart syndrome is typically brought on by highly stressful, emotional or physical triggers, often following traumatic events, such as the death of the loved one, marriage breakdown, loss of a job, a particularly upsetting argument, or a frightening medical diagnosis – even an unexpected and happy life-changing surprise, such as winning the lottery, may act as a trigger.
Physical stressors can include events such as severe pain, an asthma attack, a car accident or other extreme physical events.
Experts estimate around 60 per cent of cases of broken heart syndrome are triggered by emotional events. Physical stressors, usually in the form of acute illness, trigger around 40 per cent of cases.
In response to these triggers, the body is flooded with a huge surge of adrenaline, causing the left ventricle, the heart’s main pumping chamber, to change shape which, in turn, affects the heart’s ability to pump blood effectively.
Broken heart syndrome or heart attack?
Because the symptoms mimic those of a heart attack, including tightness, pain and shortness of breath, broken heart syndrome is often mistaken for a heart attack.
In fact, new research suggests up to 10 per cent of people who present at a hospital emergency department, suspected of having a heart attack, may in fact be suffering from broken heart syndrome. It is only when further investigations are carried out and scans show no evidence of blocked arteries but, rather, the characteristic shape of the enlarged left ventricle, that a diagnosis of ‘takotsubo’ is confirmed.
Some people may experience immediate chest pain at the time of the emotional or physical event, or the heart may develop this pain over a couple of days before it starts to recover.
In more severe cases, the heart can be paralysed for a week to 10 days before it returns to normal. Medication to aid in recovery following an incident of broken heart syndrome may include ACE inhibitors and/or beta-blockers to support your heart while it recovers, and anticoagulants to reduce the risk of blood clots.
Unlike a heart attack, for most patients, broken heart syndrome is a temporary and reversible condition with the heart muscles recovering over time. The majority make a full recovery within around two months although research suggests the condition reoccurs in around 10 per cent of people.
An experienced therapist specialising in addiction, Rosemary Brown believes “a whole lifetime of heartbreak” eventually led her to end up in the emergency department of an interstate hospital during a business trip. She was 58 at the time.
As a survivor of domestic violence and also dealing with the ongoing heartbreak of supporting her only child through substance addiction, injustice and emotional distress had long been a common theme in Brown’s life. In fact, she expressed surprise her heart “had not broken sooner”.
Although Brown had plenty of professional experience working in stressful and difficult work situations, on this particular occasion, she found herself deeply offended by a comment one of her colleagues had made.
Brown recalls feeling “a huge and overwhelming level of injustice” and admits she verbally responded in a way that was totally out of character. It was this event, she believes, that triggered a serious medical emergency.
Brown began to experience chest pain and a sensation that “something had gripped her heart and it felt frozen”. Over the next 4 to 5 hours, she tried to keep working but she was becoming increasingly unwell and was eventually taken to hospital by ambulance.
On initial examination, it appeared Brown had suffered a major heart attack but when the surgeon operated to insert some stents, they realised Brown had not suffered a heart attack, but rather the diagnosis was broken heart syndrome. She spent the next 12 days in the hospital waiting for her heart to recover before she was able to return home.
While Brown has made a full recovery, the experience has reminded her how vulnerable her heart is and the importance of looking after it.
As such, much of her professional work is now focused on counselling families supporting loved ones through addiction, encouraging them to look after their own mental and emotional health.
Preventing & reversing the damage caused
Unfortunately, up to five per cent of sufferers don’t survive an acute episode and around 20 per cent of people suffer from significant heart failure following an incident of broken heart syndrome. For those patients, the therapeutic options are limited at the moment.
However, a world-first, experimental study, currently being conducted by Monash University’s Central Clinical School, may have uncovered a way to prevent and reverse the damage caused by broken heart syndrome. Using mouse models, the team of researchers has discovered a cardioprotective drug, Suberanilohydroxamic acid, or SAHA, that targets genes in the heart.
Although there is currently no direct evidence in humans, the team at Monash University are hoping the therapeutic benefits of the drug could target and influence genes in the heart to either prevent broken heart syndrome or reverse the damage caused to the stressed heart following an attack. The next phase of the research involves recruiting patients to take part in a clinical trial.
Given the fact broken heart syndrome has an overwhelmingly uneven sex prevalence of 9:1 (women to men), if you’re female and post-menopausal, it’s important to monitor your stress levels and have your heart checked on a regular basis.
And if you’re finding it difficult to manage stress levels on your own, it is probably a good idea to seek out support, either through your regular doctor or a mental health professional.
