Relationships

The hollow ache you feel after a loved one’s death can actually lead to broken heart syndrome. Yes, it’s a real thing

It can have dire consequences for your health.
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Once upon a time a girl met a boy and fell in love. They lived happily together until one day the boy fell ill. Ravaged by sickness, he passed away. Two days later, the grieving girl died too. Sound like a tragic fairytale? Well, not completely. Turns out a broken heart can cause you harm.

Broken heart syndrome, also known as stress cardiomyopathy or takotsubo syndrome (TS) was first described in Japan in 1990. Takotsubo takes its name from a Japanese octopus trapping pot which resembles the shape of the distressed left heart ventricle seen in broken heart syndrome.

Takotsubo syndrome refers to a sudden cardiac weakening that is usually the result of severe stress. Yet it’s only in the past 10 years that TS has been recognised.

Takotsubo syndrome refers to a sudden cardiac weakening that is usually the result of severe stress.

(Credit: (Image: Getty))

“Part of the reason that takotsubo syndrome has lacked recognition is because it predominantly affects women,” says Associate Professor Sarah Zaman, academic interventional cardiologist at Westmead Hospital and The University of Sydney. “Heart disease in women has been historically under-researched and under-recognised.”

According to the British Heart Foundation, a woman is 50 per cent more likely than a man to receive the wrong initial diagnosis for a heart attack and less likely to receive potentially lifesaving treatments in a timely way. Over a 10-year period, more than 8000 women in England and Wales died needlessly due to inequalities in heart attack care, the BHF found.

“Part of the reason that takotsubo syndrome has lacked recognition is because it predominantly affects women.”

(Credit: (Image: Getty))

What’s breaking my heart?

Doctors increasingly recognise the link between emotional wellbeing and heart health. However, they’re yet to fully understand the underlying causes of TS.

The main theory is that it’s triggered by an acute stressful event that causes a release of hormones into the blood stream. “A surge of stress hormones can stun the heart muscle and affect its ability to pump effectively,” says Professor Zaman. “This causes symptoms that mimic a heart attack with chest pain, shortness of breath and sometimes collapse. In some cases, it can be life-threatening, and lead to heart injury and impaired heart function.”

Stress triggers are different for everyone, but one that’s long been associated with TS is the loss of a loved one.

In fact, TS was first described as “broken heart syndrome” because of the number of cases where partners died suddenly within days of each other. Cue our (not so) fairytale ending.

Other common triggers for TS include a sudden illness, an accident, financial loss, an asthma attack, intense fear, an operation or even a natural disaster.

In 2010 and 2011, two major earthquakes occurred in Christchurch, New Zealand. Both caused case clusters of takotsubo syndrome.

Viral surge Research published in the Journal of the American Medical Association found that the incidence of TS surged during the pandemic.

(Credit: (Image: Getty))

Avoid future heartbreak

“People with takotsubo syndrome often require considerable supportive management to help minimise the symptoms and complications of acute heart failure,” says Gemma Figtree, Professor of Medicine at Sydney University and the Northern Clinical School, Kolling Institute of Medical Research.

“This may include supporting their lungs and circulation in an intensive care environment while the heart muscle and function recovers.”

Fortunately, Professor Figtree notes that, for most individuals, heart function fully recovers.

“There is subtle evidence of ongoing inflammation in the heart muscle that may last many months after discharge from hospital. Drugs that are targeted at minimising heart muscle scarring may help with this recovery,” she says.

Given the important role emotional and physical stress plays in the syndrome, common advice, without clinical trial evidence, is to minimise likely exposure to potential trigger situations. This applies directly to those who have had recurrent takotsubo syndrome presentations.

For everyone else, the best approach to reduce the risk of TS is to minimise stress. Consistent exposure to negative stress can be associated with chronic mental health conditions including depression and anxiety. Elevated levels of stress hormones increase the risk of heart disease and stroke.

Exercise and relaxation are both very important for minimising stress,” says Professor Figtree. “Short bursts of ‘good stress’ during exercise can help improve the function of the heart, and relaxing is good for slowing the body down.”

Viral surge Research published in the Journal of the American Medical Association found that the incidence of TS surged during the pandemic, with rates increasing from less than 2 per cent to almost 8 per cent.

A heartening outlook

The future for TS recovery and prevention is important and research and studies are currently underway.

In a recent review paper, experts concluded “future efforts must be directed at establishing the diagnosis rapidly, providing education and support to improve patient understanding and recovery, and developing appropriate therapeutics”.

Meanwhile, a landmark study by Monash University has discovered a way to prevent and undo damage caused by takotsubo syndrome.

Tested on mice, Suberanilohydroxamic acid, or SAHA, provides protective benefits to genes and is currently used for cancer treatments. Monash University Professor Sam El-Osta said the study showed the drug slowed cardiac injury, and reversed damage caused to the stressed heart.

But, as for now, what’s the best advice for looking after your heart?

“Be conscious of early warning signs or red flags that your heart may be suffering,” says Professor Figtree.

“Watch for changes in exercise tolerance, chest pain or heaviness and be aware of any irregular heart rhythms,” she says. “Never hesitate

in asking for advice or visiting your GP for a heart health check.”

You can read this story and many others in the December issue of The Australian Women’s Weekly – on sale now.

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