How Romantic, Social and Financial Breakdowns Cause Broken Heart Syndrome

Women’s Cardiovascular Healthcare Foundation Issues Alert About Takotsubo
“An accumulation of intense stress leads to emotional fragility, which can end up paralyzing the cardiac muscle,” says Prof. Claire Mounier-Véhier, a cardiologist at University Hospital of Lille who cofounded Women’s Cardiovascular Healthcare Foundation with Thierry Drilhon, corporate CEO and chairman. “The heart is stunned by one too many stressful events that may have been trivial in other circumstances. This is takotsubo, also known as broken heart syndrome or stress cardiomyopathy. Its symptoms are similar to a heart attack and it mainly occurs in relatively anxious women at menopause and in people in high-risk situations. This is a cardiovascular emergency that’s still relatively unknown. It must be taken very seriously, especially during the COVID pandemic.”

What is takotsubo syndrome?
A heart muscle disease, takotsubo syndrome was described for the first time in Japan in the 1990s. While its epidemiology is similar to a heart attack, it’s not related to a coronary artery obstruction.

A situation of acute stress activates the sympathetic nervous system, triggering production of stress hormones, mainly catecholamines, that speed up the heart rhythm, increase arterial pressure and cause small coronary arterioles to contract. With the massive release of stress hormones, part of the heart is paralyzed and can no longer contract. The stunned heart balloons and takes on the shape of an amphora vase (“takotsubo” means “octopus trap” in Japanese). “This phenomenon is a potential factor in acute left ventricular rhythm disorders that can cause sudden death as well as blood clot formation in the heart with a risk for an arterial embolism,” says Dr. Mounier-Véhier. “Acute stress is a factor in the majority of cases.” However, the good news is that this form of heart failure is usually completely reversible when cardiology care is provided early.

According to a study by researchers at the University of Zurich1 published in 2015 in the New England Journal of Medicine, emotional shocks (loss of a loved one, romantic break-up, disease diagnosis, etc.) as well as physical shocks (surgical intervention, infection, accident, assault, etc.) in combination with intense fatigue (emotional and physical exhaustion) are factors that trigger takotsubo syndrome. An American study2 published in July 2020 shows that during the COVID-19 pandemic, the rate ratio of takotsubo cases during COVID increased by 4.58 in several countries, affecting people who didn’t have COVID or were only mildly ill with the virus. The cause of this takotsubo flareup was extra psychosocial stress and financial vulnerability.

Women are the most affected (9 women for 1 man) because their arteries are especially sensitive to the effects of stress hormones and spasm more easily. Women in menopause are more exposed because they are no longer protected by their natural estrogens. Women in high-risk situations with heavy psychological loads are also very exposed. “It’s essential to anticipate takotsubo syndrome by increasing psychosocial support for vulnerable women during the COVID pandemic period which is very financially difficult,” says Mr. Drilhon.

Know These Symptoms to Get Urgent Treatment
The most frequent symptoms include shortness of breath, sudden chest pain that mimics a heart attack and radiates into the arm and jaw, palpitations, loss of consciousness, and dizziness.
“A woman over the age of 50 who is in menopause and experiencing a breakdown should not underestimate the initial symptoms related to acute emotional stress,” says Dr. Mounier-Véhier. “Takotsubo syndrome requires emergency hospitalization to avoid serious complications and provide care in a cardiovascular intensive care unit. It’s so important to call 911. Just like with a heart attack, every minute counts!” While symptoms are often very pronounced, diagnosing takotsubo syndrome requires complementary examinations. These include an electrocardiogram (non-systematic abnormalities), biomarker testing (moderately elevated troponins), an echocardiogram (specific signs of ballooned heart), a coronary angiography (often normal) and a cardiac MRI (specific signs). A diagnosis will be made based on combined analysis of all these tests. In most cases, takotsubo syndrome is completely reversible within several days or weeks with medical treatment for heart failure, cardiovascular rehab and regular cardiology check-ups. Takotsubo syndrome rarely reoccurs, reappearing in about 1 out of 10 cases.

Act to Prevent
To limit acute and chronic stress, Women’s Cardiovascular Healthcare Foundation recommends maintaining your quality of life by eating a balanced diet, not smoking, and consuming very moderate amounts of alcohol. Physical activities like walking and playing sports, and getting enough sleep are powerful solutions that work like anti-stress medications. You can also use breathing exercises to relax with techniques like cardio coherence available for free online or in mobile apps like Respirelax. Mindfulness meditation and yoga are other good options.

There’s good news!
“With positive, compassionate prevention, 8 out of 10 women can avoid cardiovascular disease,” says Mr. Drilhon. 

Bibliography

1- Clinical features and outcomes of takotsubo (stress) cardiomyopathy. Templin C, Ghadri JR, Diekmann J et al. N Engl J Med 2015 ; 373:929-38
2-Incidence of Stress Cardiomyopathy During the Coronavirus Disease 2019 Pandemic. Ahmad Jabri, Ankur Kalra, Ashish Kumar et al. JAMA Netw Open. 2020 Jul; 3(7): e2014780. Published online 2020 July 9. doi: 10.1001/jamanetworkopen.2020.14780