The ‘broken heart’ syndrome is real – and it starts in the brain!

If you know someone who went through an intense emotional experience and then suffered heart damage that was not related to a heart attack – that is most likely something called the ‘Tako-tsubo cardiomyopathy’ – or in colloquial terms – ‘broken-heart syndrome’.

It was originally described in 1990 in Japan among middle-aged women who suffered heart damage after a stressful event. The term Tako-tsubo stands for an octopus trap that resembles a pot-like shape of a stricken heart. More research over the years has shown that more than 90% of these cases are reported in middle-aged women in their 50s – 70s.

It feels like a sudden, intense chest pain that can be caused by an emotionally stressful event. It could be the death of a loved one or even a divorce, breakup or physical separation, betrayal or romantic rejection. It could even happen after a good shock (like winning the lottery). The precise cause isn’t known, but experts think that surging stress hormones (for example, adrenaline) essentially “stun” the heart, triggering changes in heart muscle cells or coronary blood vessels (or both) that prevent the left ventricle from contracting effectively. Older women may be more vulnerable because of reduced levels of estrogen after menopause.

Tako-tsubo cardiomyopathy may be misdiagnosed as a heart attack because the symptoms and test results are similar. In fact, tests show dramatic changes in rhythm and cardiac biomarkers that are typical of a heart attack. But unlike a heart attack, there’s no evidence of blocked heart arteries in broken heart syndrome. A part of the heart temporarily enlarges and doesn’t pump well, while the rest of the heart functions normally or with even more forceful contractions. As a result, it may appear like the apex of the heart is expanding like a balloon with every contraction – and is also called the apical ballooning syndrome.

The good news is that patients with broken-heart syndrome usually recover within a few weeks, although some patients may suffer longer-term damage. It is recommended that these patients stay on the standard medical treatments for heart failure for a long time to prevent relapse.

Scientists have now shown for the first time that the brain plays a role in the origin of the broken-heart syndrome. They found that regions of the brain responsible for processing emotions and controlling the unconscious workings of the body, such as heart beat, breathing and digestion, do not communicate with each other as well in these patients as in healthy people. In a study published in the European Heart Journal recently, neuroscientists and cardiologists collaborated and carried out MRI brain scans in 15 patients with Takotsubo cardiomyopathy taken from the InterTAK Registry, established at the University Hospital Zurich, Switzerland, in 2011. They compared the scans with those from 39 healthy people. The scans were performed between July 2013 and July 2014. They found that these patients had decreased communication between brain regions associated with emotional processing and the autonomic nervous system, which controls the unconscious workings of the body, compared to the healthy people. This is the first step in advancing the understanding of this complex disease and would hopefully pave the way for developments in preventive, therapeutic and diagnostic strategies to improve patient care.

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