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As we celebrate Valentine’s Day in February, many of us take stock in our personal relationships. For some, Valentines Day can be a evening of joy—celebrating a satisfying and successful long term companionship with a partner. For others, it may be a time of sadness due to the loss of a loved one or the memories of a broken relationship. Many of us have heard tragic stories of elderly, long married couples—when one spouse dies, the other “heartbroken” spouse dies not long after. Does a broken heart really affect your cardiovascular health? Is there really a “heart-brain” connection?
Believe it or not, there is a real disease called Broken Heart Syndrome. Also known at Takotsubo’s cardiomyopathy or Stress induced cardiomyopathy, this disease can actually mimic the symptoms of a real heart attack. Researchers have long established a connection between mental health, anxiety, depression, emotional stress and heart disease. When we are placed under extreme stress, our bodies naturally release stress hormones such as adrenaline (otherwise known as epinephrine), norepinephrine and cortisol into the blood stream. These stress hormones are important for survival of early man—these “fight or flight” chemicals stimulate our cardiovascular system. In response to stress hormones our heart rate increases, or breathing increases and blood is preferentially sent to the skeletal muscles in order to prepare our bodies for battle.
Broken Heart Syndrome can occur in healthy individuals during periods of extreme stress. When the body releases large amounts of the stress hormones, patients with Takotsubo’s experience crushing chest pain, shortness of breath and can have changes in their heart rhythm, blood pressure and blood chemistry that are identical to those seen in the setting of a heart attack. However, these patients do not have the traditional blockages in the coronary arteries (blood vessels that supply the heart muscle) that are known to cause heart attacks. The heart muscle DOES severely dilate and begin to pump very poorly for a period of time. More women than men are affected by Takosubo’s, and fortunately, almost all patients completely recover. In fact, 90% of reported cases have been in females and the vast majority of these women have been post-menopausal. However, during the acute phase of the syndrome, the heart can be severely weakened and patients can have severe congestive heart failure requiring emergency treatments and hospitalization.
While no one knows for sure exactly what causes broken heart syndrome or who is most at risk, it does appear that extreme life stressors—both good and bad—can lead to the development of Takosubo’s. Events such as the death of a loved one, a divorce, breakup or romantic rejection, or even winning the lottery can serve as triggers. The diagnosis of Takosubo’s is made by performing an angiogram (taking pictures of the of the heart arteries and the pumping chamber of the heart) along with a heart ultrasound called an echocardiogram. In cases of broken heart syndrome, the heart arteries are normal and the pumping chamber is often dilated and appears to be in the shape of a fishing pot used for catching octopus in Japan—the pot is called a tako-tsubo—hence the name of the syndrome.
The treatment for broken heart syndrome is almost entirely supportive care. Initially, medicines such as beta-blockers and ACE inhibitors are given to help the heart pump more efficiently and promote remodeling of the heart muscle. Other medicines called diuretics are given to help remove the excess fluid from the lungs and other parts of the body that has collected due to the sudden weakness of the heart. In extreme cases where the patient develops cardiogenic shock, other interventions may be required to help them survive the acute phase of the disease process. For most, complete recovery is expected in several weeks as opposed to victims of a heart attack where recovery can take much longer. Most patients with Takosubo's need regular follow up with a cardiologist for several months after the event.
It is clear that there is a very complex interaction between our minds and our bodies particularly when it comes to "matters of the heart". Broken heart syndrome is one example of the connection between emotional stress and a physiologic response. In this case, an overwhelmingly stressful life event can result in serious cardiovascular complications. While we do have some understanding of Takosubo's cardiomyopathy, most of what we have surmised is based on supposition and the review of many case studies. The good news is that this syndrome is rarely fatal and that almost all patients recover fully within a matter of weeks to a few months. However, it is clear that we must do more to understand how emotions--particularly stress--can have a negative impact on our overall heart health.
