tag:theconversation.com,2011:/us/topics/takotsubo-cardiomyopathy-21844/articlesTakotsubo Cardiomyopathy – The Conversation2024-02-13T10:32:14Ztag:theconversation.com,2011:article/2232422024-02-13T10:32:14Z2024-02-13T10:32:14ZRomance isn’t always rosy, sometimes it’s sickening – lovesickness, erotomania and death by heartbreak explained<figure><img src="https://images.theconversation.com/files/574771/original/file-20240211-31-lmr4xk.jpg?ixlib=rb-1.1.0&rect=25%2C17%2C5681%2C3773&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.co.uk/detail/photo/lovesick-love-hurts-royalty-free-image/1500791667?phrase=love+hurts&adppopup=true">Irina Marwan</a></span></figcaption></figure><p>Absence makes the heart grow fonder. All you need is love. It’s better to have loved and lost than never to have loved at all.</p>
<p>If cliches and pop songs are anything to go by, humans spend a substantial portion of waking and sleeping hours thinking and dreaming about the pursuit of love – in all its many forms. </p>
<p>But is love all pink hearts, roses and teddy bears – or is there a darker side? Can love, or the absence of love, generate a form of sickness? Can it even lead to lasting physical or mental illness? And is it possible to die of a broken heart?</p>
<h2>Pathological Love</h2>
<p>Love can hurt. Ian McEwan framed a pathological form of affection, leading to obsession in his 1997 novel <a href="https://www.rogerebert.com/reviews/enduring-love-2004">“Enduring Love”</a>. The central character, Joe, is stalked and harassed by the mentally unwell Jed, following a tragic accident that unites them both. </p>
<p>The condition that McEwan explores so vividly is <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/de-clerambaults-syndrome-in-organic-affective-disorder/CF53A60A1E29C1AF88C13BB038C4B406">erotomania</a>, which was described by de Clerembault in 1942, and the syndrome still bears his name today. It describes the delusional but unwavering belief of being secretly but nonetheless intensely loved by another person. </p>
<p>De Clerembault was not the first person to notice these symptoms. They appear even in the words of Hippocrates, described as a form of unrequited love. The condition has seen a renaissance, over the past three centuries, shifting from unanswered love to sex addiction, to its current standing of delusions of love. </p>
<p>There are many true life examples of erotomania documented in the press. Like in “Enduring Love”, the condition can have murderous undertones. In 1981, John Hinckley Jr was arrested and institutionalised for attempting to assassinate US president Ronald Reagan. His motive? An attempt to impress the actress Jodie Foster, with whom he had become obsessed. </p>
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<h2>I love Paris in the springtime</h2>
<p>Love, or perceptions of love for material objects or places rather than individuals might also be enough to trigger psychiatric illness. </p>
<p>Take the observations of Stendhal, the pseudonym of 19th century Frenchman Marie-Henri Beyle. Stendhal was not a psychiatrist, but a writer, who found himself overcome by the <a href="https://www.scielo.br/j/anp/a/3yRYFFQsTRBfhjCzGPjnsNm/?lang=en">beauty of Florence</a> when travelling there in 1817. Both art and architecture – such as the statue of Michaelangelo’s David or the Basilica of Santa Croce - were overwhelming enough to induce dizziness, palpitations, even fainting episodes in both Stendhal and in many other <a href="https://casereports.bmj.com/content/2009/bcr.06.2008.0317.long">Florentine tourists</a> since. A resident psychiatrist recounted many observations of the cluster of symptoms during her time at the local hospital.</p>
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<p>Stendhal syndrome lacks the evidence to be classified formally as a disease – but visits to other cities can also induce similar symptoms. Anyone who seen depictions of Paris in film and fiction, as a city dripping with romance, fantasy and allure, often form a detailed and exciting image of it in their mind.</p>
<p>For many tourists, Paris lives up to these expectations, and more. For others, unfortunately not – leading to a condition known as Paris Syndrome. Realising that the city and its residents don’t conform to their preconceived ideas can prove too great a disappointment for some, who can suffer from a severe form of <a href="https://www.independent.co.uk/travel/europe/france/paris/paris-syndrome-france-b2481464.html">culture shock</a>; sweating, racing heart, nausea and vomiting, even hallucinations may ensue. </p>
<h2>Too many broken hearts in the world</h2>
<p>For centuries, romance novels have included the <a href="https://books.google.co.uk/books?hl=en&lr=&id=KtIFRJXo9XYC&oi=fnd&pg=PP2&dq=broken+heart+trope+romance+&ots=pebYRUqrIt&sig=29yj9D3-kaOp_H7cTlV3nOKa2OU&redir_esc=y#v=onepage&q&f=false">trope of the tragic</a> brokenhearted character, wasting away because of lost love – but is there science to back up this claim? </p>
<p>Well, yes. The term broken heart syndrome applies to a genuine cardiac condition – <a href="https://www.bhf.org.uk/informationsupport/conditions/cardiomyopathy/takotsubo-cardiomyopathy">Takotsubo cardiomyopathy</a>. This rare condition can generate patterns of acute heart failure, appearing in signs and symptoms, and even in blood tests and ECG (or electrocardiogram – the electrical tracing of cardiac function) to be a myocardial infarction, or heart attack. </p>
<p><a href="https://nataliemeister.ch/TAKOTSUBO">Takotsubo</a>, in case you were wondering, is a specialised Japanese fishing pot used to fish for octopus, to which the ballooned and dysfunctional heart bears a close resemblance.</p>
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<p>The underlying cause of <a href="https://heart.bmj.com/content/103/18/1461.long">broken heart syndrome?</a> Severe stress – from the emotional upheaval of a relationship break up, or <a href="https://www.bhf.org.uk/informationsupport/conditions/cardiomyopathy/takotsubo-cardiomyopathy">death of a loved one</a>. It is an example of how psychologically driven stress can impact upon the body physically. The biological response which helps our bodies to respond to stressors causes the release of <a href="https://www.medicalnewstoday.com/articles/catecholamines">catecholamine hormones</a> – among them, adrenaline. The raised levels of adrenaline have been proposed as an underlying cause of broken heart syndrome – a link between heart and mind – though more research is required to tell for sure. </p>
<p>The good news is that <a href="https://pubmed.ncbi.nlm.nih.gov/32039951/">broken heart syndrome is treatable</a>, using the same medications as are used for a heart attack, and in the vast majority of cases is a reversible phenomenon. </p>
<p>Love really is all around, and has more consequences for health and wellbeing than you might think. The brain and heart are inextricably linked, and conditions of each give us insight into the complexity of love and its effect on our bodies and minds.</p><img src="https://counter.theconversation.com/content/223242/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dan Baumgardt does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Love conquers all… apart from obsession, heart break or those seriously disappointed with ParisDan Baumgardt, Senior Lecturer, School of Physiology, Pharmacology and Neuroscience, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2047792023-05-23T16:19:27Z2023-05-23T16:19:27ZCannabis can have serious health effects that Canadians may not be aware of, like nonstop vomiting and heart issues<figure><img src="https://images.theconversation.com/files/524516/original/file-20230504-27-tqv597.jpg?ixlib=rb-1.1.0&rect=166%2C8%2C2536%2C1304&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The government has an obligation to ensure that information about the health risks of cannabis use is as equally accessible to the public as cannabis products have become.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/montreal-canada-september-13-2018-official-1178920882">(Shutterstock)</a></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/cannabis-can-have-serious-health-effects-that-canadians-may-not-be-aware-of--like-nonstop-vomiting-and-heart-issues" width="100%" height="400"></iframe>
<p>Non-medical cannabis has been legal in Canada since 2018. Although a primary motivation for legalization was to <a href="https://laws-lois.justice.gc.ca/eng/acts/c-24.5/page-1.html#docCont">enhance public awareness of the health risks associated with cannabis use</a>, the Canadian government’s <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/health-effects.html">online resources</a> regarding cannabis harms may not reveal the full picture. </p>
<p>Well-known health impacts of cannabis use include <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/health-effects/effects.html">respiratory issues, decreased cognitive ability, psychosis and risk of future substance use</a>. </p>
<p>Recently, <a href="https://www.canada.ca/en/health-canada/services/publications/drugs-health-products/cannabis-addictive.html#s5">cannabis dependence</a> has been identified as a risk for users of all ages. Approximately <a href="https://doi.org/10.1016/j.drugalcdep.2010.11.004">one in 10 adults</a> and <a href="https://doi.org/10.1016/S0140-6736(09)61037-0">one in six adolescents</a> who experiment with cannabis will become dependent. The risk increases to <a href="https://doi.org/10.1056/NEJMra1402309">one in two for daily users</a>.</p>
<p>Chronic use refers to <a href="https://www.ccsa.ca/clearing-smoke-cannabis-highlights">weekly or more frequent cannabis use over a period of months or years</a>. Chronic cannabis users are at risk of more severe and less frequently discussed health consequences. Examples include <a href="https://doi.org/10.1503/cmaj.140154">cannabinoid hyperemesis syndrome (CHS)</a> and <a href="https://doi.org/10.1161/CIRCULATIONAHA.111.052662">Takotsubo cardiomyopathy (TTC)</a>. </p>
<p>These conditions are rarely mentioned in the media. They are also absent from Canada’s online consumer resources on cannabis, despite their potential to be debilitating and, <a href="https://doi.org/10.1111/1556-4029.13819">in some cases, fatal</a>. More research is required to gauge the incidence rates of these conditions. </p>
<h2>Cannabinoid hyperemesis syndrome</h2>
<p>Cannabinoid hyperemesis syndrome, <a href="https://doi.org/10.1136/gut.2003.036350">first defined in 2004</a>, refers to cyclical vomiting experienced by chronic cannabis users (“emesis” means vomiting). People who have CHS can exhibit <a href="https://www.doi.org/10.1007/s13181-016-0595-z">reoccurring episodes of nausea, vomiting, abdominal pain and dehydration</a>, sometimes requiring hospitalization.</p>
<p>CHS is typically divided into three stages. In the first, prodromal phase, an individual starts to negatively react to cannabis, but vomiting has not begun. Symptoms include <a href="https://doi.org/10.1016/j.jen.2020.11.006">nausea, abdominal pain, heavy indigestion and lack of appetite</a>. This initial phase can last for months to years, during which most affected people maintain normal eating habits.</p>
<p>Next is the hyperemetic phase, characterized by cyclic vomiting or “hyperemetic episodes.” Patients report intense and overwhelming vomiting during this phase. <a href="https://doi.org/10.2147/IJGM.S49701">Some find that hot showers or baths temporarily ease their nausea</a>. </p>
<p>The hyperemetic phase continues until the individual stops using cannabis. Once cannabis use has ceased, the recovery phase starts.</p>
<p>Currently, the <a href="https://doi.org/10.1080/15563650.2023.2183790">most informative online resources regarding CHS are hosted on Reddit</a>, in threads such as <a href="https://www.reddit.com/r/CHSinfo/comments/wxwf41/cannabinoid_hyperemesis_syndrome_chs_a_complete/">r/CHSinfo</a>. While cases of CHS are not well-documented, evidence suggests that the <a href="https://doi.org/10.1001/jamanetworkopen.2022.31937">commercialization of the cannabis market led to an increase in CHS-related emergency department visits</a>. Increased public awareness of CHS could help address these trends. </p>
<h2>Takotsubo cardiomyopathy</h2>
<p>Takotsubo cardiomyopathy, <a href="https://doi.org/10.1097/01.JAA.0000654368.35241.FC">also known as “broken heart syndrome,”</a> is an acute reversible heart failure condition characterized by the weakening of the heart’s left ventricle, <a href="http://dx.doi.org/10.1016/j.ijcard.2016.02.012">often caused by severe emotional or physical stress</a>. “Takotsubo” refers to the <a href="https://doi.org/10.1067/mhj.2002.120403">apical ballooning shape in TTC, which resembles Japanese octopus traps</a>. </p>
<p>Although originally believed to be a benign condition, <a href="https://doi.org/10.1016/j.jacc.2018.07.072">there is a substantial risk of mortality with TTC</a>.</p>
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<span class="caption">Illustration of the mechanism linking cannabis use, stress, and Takotsubo cardiomyopathy proposed by Ma, Del Buono, and Moeller in 2019. Brain and heart icons courtesy of Freepik.</span>
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<p>TTC is most common in post-menopausal women, however, studies have <a href="https://doi.org/10.1007/s11886-019-1210-0">suggested a link between chronic cannabis use and TTC in younger individuals</a>. <a href="https://doi.org/10.7759/cureus.18575">Incidents of TTC in cannabis users are associated with serious illness</a> including stroke and cardiac arrest, even though these patients usually have more favourable cardiac risk factor profiles compared to older, non-cannabis using patients.</p>
<p>While the interplay between chronic cannabis use and TTC remains unclear, <a href="https://doi.org/10.1007/s11886-019-1210-0">researchers have hypothesized cannabis use and stress have similar hyperactivation effects on the amygdala</a>, a structure located in the brain’s temporal lobe. <a href="https://doi.org/10.1007/s10286-021-00844-z">Excessive activation of the amygdala and the sympathetic nervous system is believed to be a dominant contributor to TTC</a>.</p>
<h2>The cost of chronic cannabis use</h2>
<p>Although I research cannabis, I was unaware of TTC and CHS until I heard Liv Wilder’s story in <a href="https://open.spotify.com/episode/2Wzxibub1lBF8Qi5IIKLcU">episode 135 of the <em>This Is Actually Happening</em> podcast</a>. I reached out to Wilder, who lives in the United States, to ask about his experience with cannabis and these conditions, which he also <a href="https://www.instagram.com/all.in.amputee/">discusses on Instagram</a>.</p>
<p>When Wilder was introduced to cannabis at age 20, he found a new sense of peace after struggling with anxiety and alienation since childhood. He began using cannabis daily. </p>
<p>After several months, he began experiencing intense nausea and vomiting that would last for hours. Some episodes required emergency room visits, where he received intravenous anti-nausea medication, but no clear diagnosis.</p>
<p>When Wilder switched from dried flower to concentrates, <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/personal-use/accessories-inhalation.html#a4">colloquially known as “dabs</a>,” the higher dose of cannabinoids increased the frequency of his nausea and vomiting. Over the next two years of cannabis use, his nausea and vomiting became increasingly tortuous.</p>
<p>After a minor, unrelated surgical procedure performed under general anesthesia, Wilder breathed vomit into his lungs during recovery, turned blue and was rushed to emergency. </p>
<p>The apex of his heart had ballooned due to the stress of the anesthesia, years of chronic cannabis use and persistent vomiting. He was put on dialysis and life support, which led to a blockage in his right femoral artery, resulting in his foot becoming necrotic. His leg was amputated while he remained in a coma. </p>
<p>He woke up some time after his surgery as an above-the-knee amputee. Three years of chronic cannabis use had cost him his right leg.</p>
<p>Wilder was diagnosed with TTC, CHS, acute kidney injury and neuropathy in his left foot. He struggled with cannabis and alcohol abuse for 18 months following his amputation, but has abstained from both since July 2019. He is now very active in the gym, and loves rock climbing and camping. </p>
<h2>Improving cannabis education</h2>
<p>At present, occurrence rates of CHS and TTC in Canada remain unclear. According to the <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/canadian-cannabis-survey-2022-summary.html">2022 Canadian Cannabis Survey</a>, one in five Canadian cannabis users reported daily use in the past year. <a href="https://doi.org/10.1503/cmaj.1096027">CHS has been estimated to affect one of every 200 daily cannabis users</a>. Associations between TTC and chronic cannabis use are not as well understood.</p>
<p>Providing consumers with a regulated source of cannabis that is not synthetic, contaminated with pesticides, or laced with other drugs is necessary. As a scientist who studies cannabis emissions, I am an avid supporter of legalization. Nonetheless, commercialization of the market without sufficient cannabis education contradicts the <a href="https://www.ccsa.ca/policy-and-regulations-cannabis">goal of the Cannabis Act</a>: to protect the public health and safety of Canadians.</p>
<p>Now that <a href="https://www.theglobeandmail.com/business/article-health-canada-cannabis-act-review/">Canada’s federal review of the impacts of legalization</a> is underway, it is essential to highlight chronic cannabis use and associated health risks. The government has an obligation to ensure that information about the health risks of cannabis use is as equally accessible to the public as cannabis products have become.</p><img src="https://counter.theconversation.com/content/204779/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kristen Yeh’s financial support for research on cannabis emissions comes from the Natural Sciences and Engineering Research Council, Ontario Graduate Scholarship program, the Alfred P. Sloan Foundation, and the University of Toronto Department of Chemistry.</span></em></p>Potential long-term, serious consequences of cannabis use include severe cyclical vomiting and a form of cardiomyopathy sometimes called ‘broken heart syndrome.’Kristen Yeh, PhD Candidate, Environmental Chemistry, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1828942022-07-13T15:51:56Z2022-07-13T15:51:56ZYou really can die of sadness – and also happiness<figure><img src="https://images.theconversation.com/files/467190/original/file-20220606-12-zanb9f.jpg?ixlib=rb-1.1.0&rect=16%2C24%2C5447%2C3612&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/celebrating-young-woman-mobile-phone-winning-1886782159">Monkey Business Images/Shutterstock</a></span></figcaption></figure><p>Dying of a broken heart was just a figure of speech until 2002 when <a href="https://academic.oup.com/eurheartj/article/43/18/1693/6551715">Dr Hikaru Sato</a> and colleagues at Hiroshima City Hospital <a href="https://www.sciencedirect.com/science/article/abs/pii/S0002870302833944?via%3Dihub#!">described it in a study</a>. Sato named the condition takotsubo cardiomyopathy. It was quickly dubbed “broken heart syndrome”.</p>
<p>More recently, scientists have discovered that you can also die of an excess of happiness. And it is the same condition: takotsubo cardiomyopathy. Naturally, it’s being called “happy heart syndrome”. </p>
<p>So what is takotsubo cardiomyopathy – or takotsubo syndrome, as it is also known? And why do some people die of it?</p>
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<p>First, it should be stressed that takotsubo cardiomyopathy is rarely fatal. As with other cardiomyopathies (disease of the heart muscle), most people recover <a href="https://www.health.harvard.edu/heart-health/takotsubo-cardiomyopathy-broken-heart-syndrome">within a couple of months</a> without long-term heart damage.</p>
<p>It is so named because people with the condition have an abnormally shaped left ventricle – the main pumping chamber in the heart. Sato thought the shape – narrow at the top and ballooning at the bottom – resembled the ceramic pots used to trap octopuses (takotsubo), hence the name.</p>
<p>This ballooning weakens the heart muscle, affecting its ability to pump blood effectively.</p>
<h2>More cases or better awareness?</h2>
<p>A study of around 135,000 people in the US found that the number of people diagnosed with this condition increased steadily over the 11 years that the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8751899/">study</a> was conducted (2006-2017). It is more common in women (88%) and seen most commonly in people aged 50 and over.</p>
<p>Doctors are probably finding more cases now because there is better <a href="https://pubmed.ncbi.nlm.nih.gov/26279109/">awareness</a> of the condition, <a href="https://pubmed.ncbi.nlm.nih.gov/29850871/">people are living longer</a> and there are better <a href="https://pubmed.ncbi.nlm.nih.gov/26840569/">diagnostic tools</a> to detect it.</p>
<p>Until recently, this “broken heart” syndrome was shown to be associated with <a href="https://pubmed.ncbi.nlm.nih.gov/26332547/">significant</a> emotional or physical stress. The exact mechanism by which the stress causes the change in the heart’s shape and the subsequent symptoms – chest pain and shortness of breath – is still not fully understood. </p>
<p>Doctors have noted similar harmful changes to the heart in people with conditions, such as <a href="https://pubmed.ncbi.nlm.nih.gov/23837998/">pheochromocytoma</a> (a rare tumour on the adrenal glands) and central nervous system <a href="https://pubmed.ncbi.nlm.nih.gov/25213573/">disorders</a>. In these conditions, there is an excess of <a href="https://www.ncbi.nlm.nih.gov/books/NBK507716/">catecholamines</a>, which are hormones, such as adrenaline, noradrenaline and dopamine, made by the adrenal glands. This provides a hint of the possible role of these hormones in takotsubo cardiomyopathy.</p>
<p>The role of these hormones in broken heart syndrome has been further cemented by the exact same ballooning of the heart’s left ventricle being witnessed in patients treated with these catecholamines while undergoing <a href="https://www.researchgate.net/publication/221734904_Broken_Heart_Syndrome_A_Risk_of_Teenage_Rhinoplasty">cosmetic rhinoplasty</a> (“nose job”).</p>
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<img alt="Person having a nose job." src="https://images.theconversation.com/files/472816/original/file-20220706-24-9keo6n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472816/original/file-20220706-24-9keo6n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472816/original/file-20220706-24-9keo6n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472816/original/file-20220706-24-9keo6n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472816/original/file-20220706-24-9keo6n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472816/original/file-20220706-24-9keo6n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472816/original/file-20220706-24-9keo6n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">People undergoing rhinoplasty are at risk of takotsubo syndrome.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/surgeon-his-assistant-performing-cosmetic-surgery-704245774">UfaBizPhoto/Shutterstock</a></span>
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<p>In stressful situations, these catecholamines are <a href="https://www.statpearls.com/ArticleLibrary/viewarticle/41471">increased</a> and they affect the body, particularly the heart where they are involved in increasing the heart <a href="https://www.nature.com/articles/280235a0">rate</a> and <a href="https://academic.oup.com/eurheartj/article-abstract/10/suppl_B/29/454620">strength</a> of the heartbeat. This effect in stressful situations is not a surprise, as often the body and mind go into a fight-or-flight mode, which triggers the release of these catecholamines.</p>
<p>Stressful events that can trigger takotsubo syndrome <a href="https://www.sciencedirect.com/science/article/abs/pii/S0002870307009143?via%3Dihub">include</a> receiving bad news (such as a cancer diagnosis), the loss of a loved one, domestic violence, a car accident and even public speaking.</p>
<h2>The flip side</h2>
<p>Most recently, researchers in Germany have <a href="https://www.jacc.org/doi/10.1016/j.jchf.2022.02.015">described patients with takotsubo syndrome</a> triggered by happy events, such as a wedding, the birth of grandchildren and winning the jackpot.</p>
<p>Of 910 patients in the study who had an emotional trigger for takotsubo syndrome, 37 had happy heart syndrome and 873 had broken heart syndrome. Unlike broken heart syndrome, which mainly affects women, happy heart syndrome was mostly observed in men. </p>
<p>The researchers found that deaths and complications from happy heart and broken heart syndrome are about the same, that is to say, rare. So don’t worry about getting emotional about life’s big events. They’re very unlikely to kill you. But if you do feel pain or pressure in your chest, always seek medical help.</p><img src="https://counter.theconversation.com/content/182894/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Taylor is affiliated with the Anatomical Society. </span></em></p>People have been known to die of a broken heart. New research suggests they can also die of happiness.Adam Taylor, Professor and Director of the Clinical Anatomy Learning Centre, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1060332018-11-05T14:16:49Z2018-11-05T14:16:49ZBroken heart syndrome was thought to be a short-term condition – the latest evidence suggests otherwise<figure><img src="https://images.theconversation.com/files/243652/original/file-20181102-83635-1jdo9u9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/377424988?src=N6ZJYcveMig2eLkSKIiDDg-1-17&size=medium_jpg">Stas Knop/Shutterstock</a></span></figcaption></figure><p>A stressful event, such as the death of a loved one, really can break your heart. In medicine, the condition is known as broken heart syndrome or takotsubo syndrome. It is characterised by a temporary disruption of the heart’s normal pumping function, which puts the sufferer at increased risk of death. It’s believed to be the reason many elderly couples die within a <a href="https://www.nytimes.com/2018/10/30/well/live/how-emotions-can-affect-the-heart.html">short time of each other</a>. </p>
<p>Broken heart syndrome has similar symptoms to a heart attack, including chest pain and difficulty breathing. During an attack, which can be triggered by a bereavement, divorce, surgery or other stressful event, the heart muscle weakens to the extent that it can no longer pump blood effectively. </p>
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<p>In about one in ten cases, people with broken heart syndrome develop a condition called <a href="https://www.ncbi.nlm.nih.gov/pubmed/26474843">cardiogenic shock</a> where the heart can’t pump enough blood to meet the body’s needs. This can result in death.</p>
<h2>Physical damage</h2>
<p>It has long been thought that, unlike a heart attack, damage caused by broken heart syndrome was temporary, lasting days or weeks, but recent research suggest that this is not the case.</p>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pubmed/28599831">study</a> by researchers at the University of Aberdeen provided the first evidence that broken heart syndrome results in permanent physiological changes to the heart. The researchers followed 52 patients with the condition for four months, using ultrasound and cardiac imaging scans to look at how the patients’ hearts were functioning in minute detail. They discovered that the disease permanently affected the heart’s pumping motion. They also found that parts of the heart muscle were replaced by fine scars, which reduced the elasticity of the heart and prevented it from contracting properly. </p>
<p>In a recent follow-up <a href="https://www.ncbi.nlm.nih.gov/pubmed/29128863">study</a>, the same research team reported that people with the broken heart syndrome have persistent impaired heart function and reduced exercise capacity, resembling heart failure, for more than 12 months after being discharged from hospital.</p>
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<h2>Long-term risk</h2>
<p>A <a href="https://newsroom.heart.org/news/complication-of-broken-heart-syndrome-associated-with-both-short-and-long-term-risk-of-death?preview=9f46">new study on the condition</a>, published in Circulation, now shows that the risk of death remains high for many years after the initial attack.</p>
<p>In this study, researchers in Switzerland compared 198 patients with broken heart syndrome who developed cardiogenic shock with 1,880 patients who did not. They found that patients who experienced cardiogenic shock were more likely to have had the syndrome triggered by physical stress, such as surgery or an asthma attack, and they were also significantly more likely to have died five years after the initial event. </p>
<p>People with major heart disease risk factors, such as diabetes and smoking, were also much more likely to experience cardiogenic shock, as were people with <a href="https://www.nhs.uk/conditions/atrial-fibrillation/">atrial fibrillation</a> (a type of heart arrythmia).</p>
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<p>A second <a href="https://www.sciencedirect.com/science/article/pii/S2213177918303925">study</a> from Spain found similar results among 711 people with broken heart syndrome, 11% of whom developed cardiogenic shock. Over the course of a year, cardiogenic shock was the strongest predictor of death in this group of patients.</p>
<p>These studies show that cardiogenic shock is not an uncommon risk factor in broken heart syndrome patients, and it is a strong predictor of death. They shed light on a condition that was previously thought to be less serious than it is.</p>
<p>The evidence now clearly shows that the condition is not temporary and it highlights an urgent need to establish new and more effective treatments and careful monitoring of people with this condition.</p><img src="https://counter.theconversation.com/content/106033/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nelson Chong does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Stressful events can permanently damage your heart and increase your risk of death. Scientists have been discovering more about it.Nelson Chong, Senior Lecturer, Department of Life Sciences, University of WestminsterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/574422016-04-11T14:31:30Z2016-04-11T14:31:30ZYou really can die of a broken heart – here’s the science<figure><img src="https://images.theconversation.com/files/118133/original/image-20160411-21959-ps6nll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A fatal flaw?</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&searchterm=broken%20heart&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=112793704">Shutterstock</a></span></figcaption></figure><p>When you think of a broken heart, you probably picture something out of a romantic movie or a cartoon heart, cracked like a fragile piece of china. Indeed, so-called <a href="http://www.heart.org/HEARTORG/Conditions/More/Cardiomyopathy/Is-Broken-Heart-Syndrome-Real_UCM_448547_Article.jsp">“broken heart syndrome”</a> has a certified place in popular culture, and has been eloquently used in films such as <a href="http://www.imdb.com/title/tt0332280/">The Notebook</a>. But while we certainly feel “heartbreak” during periods of emotional upheaval, can you actually die of a broken heart? </p>
<p>The answer is never going to be simple, so first we should start with a bit of science. In the last two decades, <a href="http://www.nhs.uk/Conditions/atrial-fibrillation/Pages/Introduction.aspx">atrial fibrillation (AF)</a>, a form of irregular heartbeat, has become one of the most important public health problems and a significant cause of increasing healthcare costs in western countries. </p>
<p>Individuals with AF have a five-fold and two-fold increased risk of stroke and death, respectively. It is <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064952/">estimated</a> that there will be 14-17m AF patients in Europe by 2030; with 120,000–215,000 new cases diagnosed each year. In the United States, AF prevalence is <a href="http://www.ajconline.org/article/S0002-9149(13)01288-5/abstract">projected</a> to increase from 5.2m in 2010 to 12.1m cases in 2030. </p>
<p>The exact cause of AF is still unresolved and is likely to involve multiple components such as genetic and environmental factors. Atrial fibrillation is a progressive condition, whereby the arrhythmia begins in a “sudden onset” form, progressing through “persistent” to so-called “permanent” AF. These steps can take many years to develop, but an essential element in this progression are the so-called “triggers”, which can be anything from illness and fatigue, to alcohol, caffeine and emotional stress.</p>
<h2>Bereavement and ‘broken hearts’</h2>
<p>But what does this have to do with a broken heart? Well, it appears that the two are linked. In a <a href="http://openheart.bmj.com/content/3/1/e000367.abstract">recent article</a> published in the online journal Open Heart, a Danish research team based at Aarhus University reported findings showing that the death of a partner is linked to heightened risk of developing AF for up to a year after the bereavement. </p>
<p>This retrospective study examined hospital records of 88,612 people in Denmark (19.72% of whom had lost a partner) and identified persons that were diagnosed with AF for the first time between 1995 and 2014. For comparison, the team also randomly selected a control group (without AF) of 886,120 people (19.07% of whom had lost a partner) which was matched with the AF group on age and gender. Other factors that were controlled included civil status and education level, and whether the subjects had cardiovascular disease, diabetes or were taking medication for cardiovascular disease.</p>
<p>The study revealed that individuals whose cohabiting partner or spouse had died had an increased risk of getting AF within 30 days of the bereavement – a risk estimated to be 41% higher than average.</p>
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<p>The risk was highest 8-14 days after the loss (90% higher than average) and gradually declined to a level close to that of non-bereaved population after one year. This risk was higher among people under the age of 60 and among those whose death was unexpected. Interestingly, where deaths were likely due to ill health, there was no increased risk of AF in the partners after the loss.</p>
<p>The main strengths of this study are the large sample size and the population-based design, but it is an observational study and they can’t prove the cause or the effect. Other contributory factors such as lifestyle or family history of AF could have affected the results, which the authors have acknowledged. </p>
<p>What would have provided more insight to this study is if blood biomarkers (indicating heart damage) or stress hormones (such as adrenaline) were monitored during hospital admission, or whether there were other more serious heart problems, such as heart failure, which would have been detectable with the use of <a href="https://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300438.pdf">echocardiography</a>.</p>
<h2>The origins of a broken heart</h2>
<p>Scientific findings accumulated over the past 25 years seem to support the notion that a real-life broken heart can lead to subsequent heart problems. “Broken heart syndrome”, also known as stress-induced cardiomyopathy or Takotsubo cardiomyopathy, was first described in 1990 in Japan and has recently been globally recognised as a <a href="https://www.bhf.org.uk/heart-health/conditions/cardiomyopathy/takotsubo-cardiomyopathy">real medical condition</a>. </p>
<p>It should be noted here that without echocardiography, blood markers and other evidence, we can’t say for sure whether those in the published Danish cohort had “broken heart syndrome” or not. Nevertheless, roughly in keeping with the condition described in the Danish study, Takotsubo cardiomyopathy starts abruptly and unpredictably (even in healthy individuals). Symptoms include chest pains, often with shortness of breath, and an abnormal electrocardiogram, which resembles a heart attack but is notable for the absence of blocked heart blood vessels. </p>
<p>Indeed, Takotsubo syndrome <a href="http://www.health.harvard.edu/heart-health/takotsubo-cardiomyopathy-broken-heart-syndrome">accounts</a> for about 2-5% of heart attack cases seen by doctors, with a higher predilection for women over 50 years of age (only 10% in men). The significance of Takotsubo cardiomyopathy is reflected to the fact that there is an <a href="http://www.takotsubo-registry.com">international registry for this disorder</a>. </p>
<p>What is interesting is that Takotsubo cardiomyopathy is usually triggered by an emotionally or physically stressful event such as bereavement, major surgery or being involved in a disaster such as an earthquake. The exact mechanisms leading to Takotsubo cardiomyopathy are unknown but some evidence suggests excessive release of stress hormones, such as adrenaline, acts as a trigger during the initial onset which causes the weakening of the heart muscle. </p>
<p>In fact, the strong emotion doesn’t have to be negative – <a href="http://www.ncbi.nlm.nih.gov/pubmed/26935270">“happy heart syndrome”</a> is initiated by happy events, such as the birth of grandchildren or a birthday, and accounts for 1.1% of <a href="http://www.readcube.com/articles/10.1038/nrcardio.2016.41">broken heart syndrome cases</a>.</p>
<p>The long-term affects of Takotsubo cardiomyopathy are unclear, but it does appear to be temporary and reversible. Nevertheless, it is certain that we can have our hearts broken – and that, for some, this can be very dangerous indeed.</p><img src="https://counter.theconversation.com/content/57442/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nelson Chong does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In fact, even a happy heart can break.Nelson Chong, Senior Lecturer, Department of Life Sciences, University of WestminsterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/461312015-11-19T19:06:31Z2015-11-19T19:06:31ZFact or fiction: can we die from a broken heart?<figure><img src="https://images.theconversation.com/files/99110/original/image-20151021-32272-1g79mmi.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Broken heart syndrome is a real thing.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Dying of a broken heart is more than a myth. <a href="http://www.mayoclinic.org/diseases-conditions/broken-heart-syndrome/basics/definition/con-20034635">Takotsubo cardiomyopathy</a> (also known as broken heart syndrome) is a condition first recognised by Japanese researchers more than 20 years ago, and it has gained a great deal of attention in Western countries in the past ten years. </p>
<p>Takotsubo cardiomyopathy (TTC) temporarily affects the ability of the heart to pump efficiently. When this happens, the person experiences the same symptoms as those of a heart attack, including chest pain and shortness of breath. Less commonly, it can cause death.</p>
<p>Although the symptoms of a heart attack and TTC are the same, they have different causes. Whereas a heart attack is caused by a blockage in one of the coronary arteries supplying the heart muscle, the exact mechanism of TTC is not entirely clear.</p>
<p>TTC is associated with patterns of abnormal contraction of the left ventricle, the heart’s main pumping chamber, but it is not caused by blocked coronary arteries. The condition is being widely researched internationally, but it is generally accepted by the scientific community that stress hormones, such as adrenalin, are partly at fault.</p>
<h2>What causes broken heart syndrome?</h2>
<p>In most cases TTC is preceded by severe psychological or physical stress. The condition was first recognised in women who had experienced a traumatic emotional event, such as the death of a spouse. Hence, the commonly used name “broken heart syndrome”. </p>
<p>The types of stressors associated with TTC vary widely, from what may seem to be trivial events to severe life-changing events. Some of the more common psychological stressors include death of a spouse or other significant family member, family arguments, negative events in the workplace, psychiatric illness, loss of property, loss of a pet, anniversary of a death and traumatic social or environmental events such as war, earthquakes and floods.</p>
<p>Examples of commonly reported physical stressors include acute medical illness or trauma, stroke, epilepsy, heat stress, being diagnosed with diseases such as cancer and giving birth. </p>
<p>The list of stressors associated with TTC appears to be endless. From the thousands of cases reported, it seems almost anything can cause TTC if it elicits a stress response in an individual. It has been <a href="http://www.sciencedirect.com.ezlibproxy.unisa.edu.au/science/article/pii/S0828282X14015748">suggested</a> that TTC can even occur with emotional responses to happy events.</p>
<h2>Who suffers?</h2>
<p>According to <a href="https://www.jstage.jst.go.jp/article/circj/78/9/78_CJ-14-0770/_article">research</a>, TTC appears to predominantly affect postmenopausal women. Around 90% of reported cases are in women aged between 65 and 70 years. As the condition becomes more widely recognised, cases are being reported in other groups, including younger women, men and children.</p>
<p>It is not clear why women seem to be more susceptible to the development of TTC, or why some people and not others develop TTC in response to a stressful event. It may be that some of us have less psychological resilience to stress. Alternatively, it may be a physical factor in some people, such as an inability by their body to cope with sudden large amounts of stress hormones.</p>
<h2>How is it diagnosed?</h2>
<p>The diagnosis of TTC is usually made when a person presents to an emergency department with heart attack symptoms and undergoes coronary angiography, a procedure to examine the coronary arteries for blockages. </p>
<p>During angiography, clinicians will note that a coronary artery blockage is not the cause of the symptoms. Rather, they will see the abnormal contraction pattern of the left ventricle associated with TTC.</p>
<p>TTC occurs in around 2% of people who have coronary angiography for a suspected heart attack, but there is no doubt that TTC is under-recognised. There are a few reasons for this. </p>
<p>At the time TTC was first recognised in Japan, there was little interest from the West in what was initially thought to be a rare phenomenon. Also, stress is not a good fit in the paradigm of cardiovascular disease development where risk factors such as blood pressure, cholesterol, age and weight can be precisely measured for risk management and treatment. And our incomplete understanding of TTC limits our ability to recognise all situations in which TTC may occur, in whom and to what extent. </p>
<p>TTC can cause death but this is relatively rare and often associated with a concurrent medical illness. The good news is that most people with TTC make a full recovery within a few weeks. Some people will have recurrent episodes and as yet we do not have any therapies to prevent this.</p>
<h2>Treatment</h2>
<p>The treatment for TTC is initially the same as for a heart attack, but once TTC is diagnosed, there will be some changes to medications. Drugs known as angiotensin-converting enzyme (<a href="http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/ace-inhibitors/art-20047480">ACE</a>) inhibitors (which relax the blood vessels) and <a href="http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/beta-blockers/art-20044522">beta blockers</a> (which control heart rhythm and reduce high blood pressure) are generally used to reduce the workload on the heart. But currently it is not clear which medications are most helpful in treating TTC or for how long they should be used.</p>
<p>There is <a href="http://www.webmd.com/heart-disease/features/rein-in-rage-anger-heart-disease">increasing evidence</a> that negative emotions including stress, depression, anger, frustration, panic, fear and anxiety are associated with an increased risk of developing heart problems. They are also associated with poorer outcomes for people with existing heart problems. </p>
<p>TTC is yet another example of the adverse effects of stress on health. With heightened awareness of the condition, and increasing levels of stress in our society, we are likely to see a greater incidence of TTC over time.</p><img src="https://counter.theconversation.com/content/46131/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Angela Kucia does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Dying of a broken heart is more than a myth. Takotsubo Cardiomyopathy, also known as Broken Heart Syndrome, was first recognised by Japanese researchers over 20 years ago.Angela Kucia, Senior Lecturer in Nursing, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/137642013-05-16T10:30:06Z2013-05-16T10:30:06ZA broken heart has some truth to it after all<figure><img src="https://images.theconversation.com/files/23880/original/4tm3yw9k-1368642010.jpg?ixlib=rb-1.1.0&rect=10%2C10%2C1093%2C715&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Are women are more likely to survive broken heart syndrome?</span> <span class="attribution"><span class="source">Gabriela Camerotti</span></span></figcaption></figure><p>We’re all familiar with the idea of a broken heart, used to describe the emotional and sometimes physical pain of losing a loved one. It’s not uncommon <a href="http://www.dailymail.co.uk/news/article-2309283/Widower-72-dies-broken-heart-just-hours-wife-loses-fight-lung-disease.html">to hear a broken heart blamed</a> when someone dies not long after a much-loved partner. </p>
<p>But it wasn’t until recently that heart doctors identified a new heart condition that may shed some new light on these more anecdotal tales. Because it’s usually triggered by a severely stressful event, such as discovering the death of a loved one, it has become known as broken heart syndrome in the context of bereavement. But in medical circles we know it as Takotsubo Cardiomyopathy. </p>
<p>Over the past 20 years there has been a revolution in how we treat heart attacks. In the developed world, the vast majority of people arriving in A&E with severe cardiac chest pain (angina) and the changes to their heart tracing (the ECG that we’re all now used to seeing on heart monitors on TV and in the news) that suggest a heart attack, are fast tracked to a special unit.</p>
<p>Here doctors take angiograms, by tracing the movement of liquid injected into the heart to find <a href="http://www.nhs.uk/Conditions/Heart-attack/Pages/Introduction.aspx">the blocked coronary artery</a> that normally causes a regular heart attack.</p>
<h2>Something different about Takotsubo</h2>
<p>But sometimes someone arrives at the hospital who seems to be having a regular heart attack but isn’t. They have chest pains, a shortness of breath and ECG monitors show the same extreme changes which we see with a heart attack. </p>
<p>But when an angiogram is performed, none of their coronary arteries are blocked. Instead, the lower half of their ventricle, the main pumping chamber of their heart, shows a very peculiar and distinctive abnormality - it fails to contract, and appears partially or completely paralysed.</p>
<p>The top half carries on beating normally or even more aggressively than usual to compensate for the paralysed lower half. When a picture of the heart is taken, it resembles a vase with a narrow neck and bulbous lower half. It was initially recognised in Japan in earthquake survivors (a major stress!), and named after the Japanese fishermen’s octopus traps that resemble the problem heart. Before Takotsubo was identified these patients were treated as if they were having a heart attack.</p>
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<img alt="" src="https://images.theconversation.com/files/23879/original/bq5rt6jj-1368641110.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/23879/original/bq5rt6jj-1368641110.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/23879/original/bq5rt6jj-1368641110.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/23879/original/bq5rt6jj-1368641110.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/23879/original/bq5rt6jj-1368641110.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=497&fit=crop&dpr=1 754w, https://images.theconversation.com/files/23879/original/bq5rt6jj-1368641110.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=497&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/23879/original/bq5rt6jj-1368641110.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=497&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The distinctive octopus pot-shaped heart of someone suffering from Takotsubo.</span>
<span class="attribution"><span class="source">Wikimedia Commons/Gangadhar/Von Lohe</span></span>
</figcaption>
</figure>
<p>In severe cases, people need to be admitted to hospital, have appropriate monitoring and given intensive treatment. In the most extreme cases the heart can stop - a cardiac arrest. But with treatment and in milder cases, the heart amazingly recovers, which doesn’t happen with heart attacks. Several weeks or months later and you can be back to normal, with no scarring of the heart muscle, which you get with true heart attacks.</p>
<p>We don’t currently know how common cardiomyopathy is in society. Observations from various hospitals around the world have consistently reported a figure of about 2% of all people who show up looking like they are having a heart attack.</p>
<p>As a guide, and <a href="http://www.bhf.org.uk/media/news-from-the-bhf/bhf-facts.aspx">a back of the envelope calculation</a>, this suggests that in the UK some 3000 to 4000 people suffer from Takotsubo every year. </p>
<p>Intriguingly, more than 90% of people who experience this condition are middle-aged or elderly women, all postmenopausal. It is not clear whether they are the survivors, and men drop dead suddenly with severe stress, or whether the postmenopausal female heart is more sensitive to adrenaline.</p>
<h2>Adrenaline looks a likely culprit</h2>
<p>To paraphrase Donald Rumsfeld, there are many known unknowns when it comes to broken heart syndrome but we’re learning much more about this fascinating condition and why the heart undergoes this temporary paralysis in just one area. We suspect it’s triggered by adrenaline, one of the body’s main stress hormones, often associated with <a href="http://www.nottingham.ac.uk/counselling/documents/podacst-fight-or-flight-response.pdf">fight or flight response</a>.</p>
<p>In some cases, we’ve seen Takotsubo cadiomyopathy triggered by adrenaline injections, either in medical emergencies, which are in themselves stressful, or in accidents. Research from our lab at Imperial College London <a href="http://circ.ahajournals.org/content/early/2012/06/25/CIRCULATIONAHA.112.111591.abstract">would also support a central role for adrenaline</a>. </p>
<p>At low and medium levels adrenaline is a stimulating hormone, triggering the heart to beat harder and faster, which we need during exercise or stress. However at the highest levels it has the opposite effect and can reduce the power the heart has to beat and triggering temporary heart muscle paralysis. </p>
<p>We believe this is actually a protective response to prevent excessive stimulation to the heart muscle. Paradoxically, by triggering the paralysis, this may protect the heart from extreme severe stress. Most people recover from the acute Takotsubo episode, and although the initial phase can be high risk, the long-term outlook for sufferers is very good. A few people have recurrent episodes, and in rare cases it can run in families.</p>
<p>We successfully campaigned to have Takotsubo Cardiomyopathy added to the list of data collected by the UK national audit of heart attacks so we will have a better idea of the actual numbers over the next few years. There are currently no guidelines for how to treat Takotsubo in the UK, so cardiac tests and treatment is highly variable. The Royal Brompton Hospital also now has a service to understand more about it and the people who suffer from this condition. </p>
<p>We might also learn more about how stress affects the heart in general.</p><img src="https://counter.theconversation.com/content/13764/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alexander Lyon currently receives research funding from the British Heart Foundation, EPSRC and the National Institute for Health Research (NIHR)</span></em></p>Takotsubo Cardiomyopathy – the strange heart condition that may shed some light on some anecdotal tales about broken hearts.Alexander Lyon, Senior Cardiology Lecturer at Imperial College and Consultant Cardiologist at the Royal Brompton Hospital, Imperial College LondonLicensed as Creative Commons – attribution, no derivatives.