“Le cœur a ses raisons que la raison ne connaît point...” The heart has its reasons, which reason knows nothing of… - Blaise Pascal
What is Broken Heart Syndrome?
Elena Salmoirago-Blotcher, MD, PhD
June 3, 2021
We
all know that the heart performs vital functions like pumping the
blood, oxygen and nutrients to organs in the body. Yet, when we talk
about emotions, the heart seems to have a life of its own. We all have
experienced sad or even happy moments that were so intense that we said:
“this breaks my heart” or “my heart bursts.” Indeed, in many cultures,
the heart is considered the center of emotional life.
“Le cœur a ses raisons que la raison ne connaît point...” The heart has its reasons, which reason knows nothing of…
- Blaise Pascal
What does science have to say about this? Can strong emotions cause heart problems?
Stressful events, depression, and stress have all been linked to a higher risk of heart problems. For example, studies have shown that anger
can be a powerful stressor. A research study showed that in people with
existing heart problems, just remembering an event that made them angry
is enough to reduce their heart function.
Another important stressor is grief. A large study showed that the risk of having a heart attack
is 20 times higher within the first 24 hours of the death of a
significant other. While unfortunately we all experience grief, the
impact is greatest among men and women who are already at high risk of
having a heart attack.
The stress associated with traumatic events is also an important trigger. For example, the risk of having a cardiac arrhythmia
(e.g., irregular heart beat) increased by more than twofold during the
month immediately after the World Trade Center attack on 9/11 compared
to the months preceding the incident.
All these studies show that strong emotions can be problematic.
However, strong emotions and distress are not the only causes of a heart
attack. But they are important triggers, especially for people with
existing heart problems or whose heart arteries have some degree of
narrowing, even without symptoms.
Can you actually die of a broken heart? Is Broken Heart Syndrome real?
Broken Heart Syndrome is a real condition. Doctors call it
stress-induced cardiomyopathy, or Takotsubo syndrome, because the shape
of the heart during the attack resembles an octopus trap (in Japanese:
Takotsubo). The Japanese were the first to identify this syndrome in the
early 1990s.
How common is Broken Heart Syndrome?
It is fairly uncommon, found in about three out of 100 (three
percent) hospital patients with a suspected heart attack. This condition
can strike people who never had a heart problem. In most cases, the
arteries in the heart look pretty normal when doctors examine them
through a procedure called an angiogram. It is important to note that
over 90 percent of cases occur in women after menopause and 10 percent
in men. It is also very rare in younger women. The reasons are not clear
but could be due to differences in hormone levels.
The stressors for Broken Heart Syndrome
An interesting feature is that one-third of those experiencing this
condition report a significant “emotional stressor” before the attack
(hence the name “Broken Heart Syndrome”). The stressors may include the
unexpected death of a spouse or child, being in an accident, house
fires, losing significant amounts of money, public speaking or
quarreling. Another third , instead, have “physical stressors” such as a
severe asthma attack, a serious infection, non-cardiac surgery and
strokes. And about one-third of people appear to develop Takotsubo
without any stressors at all.
The symptoms of Broken Heart Syndrome
The symptoms of the Broken Heart Syndrome are similar to signs of a heart attack
- chest pain, shortness of breath, nausea, or passing out. Unlike a
heart attack though, when doctors perform an angiogram of the heart,
they find minimal or no blockages in the heart vessels.
They also find that certain areas of the heart do not pump well while
others are super-active (thus giving the heart the shape of an octopus
trap). Studies also show that the levels of the stress hormones in the
blood are markedly higher in people with the Broken Heart Syndrome than
among those with a “regular” heart attack.
Treating Broken Heart Syndrome
The good news is that this condition is treatable. It is rarely fatal
and the large majority of patients makes a complete recovery within a
few weeks.
The less good news is that over the following year or so following an
episode of Broken Heart Syndrome, some individuals may have another
episode or be readmitted to the hospital for other cardiovascular
problems. In others, an ultrasound of the heart still shows that the
heart has not quite recovered from the first episode.
Research on Broken Heart Syndrome
Even though this condition is treatable, and we have learned a lot
about what happens when people have it, there is still a lot we do not
know. I started doing research on Takotsubo syndrome ten years ago.
As a physician, I was always very interested in the connection
between the mind and the heart. Maybe because I grew up in Italy, where
people have a big heart and are very passionate about pretty much
everything (and so am I). But my specific interest in Takotsubo was born
from the personal experience of my mother developing this condition,
and my desire to help other women.
In 2012, I was funded by the American Heart Association to do some
preliminary work. Through that research, we found that women with a
history of anxiety, symptoms of post-traumatic stress disorder, and
those with repeated stressful events in the recent past were more likely
to develop Takotsubo syndrome.
In 2020, I received a $2.8 million grant from the National Heart,
Lung, and Blood Institute to study in more depth the role of stress in Broken Heart Syndrome.
We hope that this study will help clarify which type of stressors
people experience before the attack, and how the way they respond to
stress may affect their risk of having a second episode.
What you should know about Broken Heart Syndrome
There is a strong association between emotional/stressful events and heart attacks.
Individuals with a traditional heart attack have diseased heart
arteries, while people with Broken Heart syndrome usually do not.
When exposed to a stressful event, the majority of individuals DO NOT develop the Broken Heart Syndrome.
Women after menopause are at higher risk and researchers are trying to understand why.
How to reduce your risk of Broken Heart Syndrome
Since it is impossible to control stressful events in life (as we know, things happen) – what can YOU do?
Let go of things you cannot control, and take responsibility for those you can control -- your health.
Be positive! Cultivate an optimistic attitude, as studies show a positive link between optimism and health.
Cultivate your spirituality in whatever form works for you. That might be a walk in the woods, taking a quiet moment for yourself every day, a practice such as meditation or yoga, or prayer.
For more information about our research on Broken Heart Syndrome and other studies, visit our website.
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