What if the pain felt after losses and traumas, arguments and the stress of watching the match really "breaks" your heart? What are the factors that trigger this condition known as Takotsubo Syndrome? Are you at risk?
Science reveals that “heartbreak” is not just a metaphorical expression of suffering in the books we read and the songs we listen to. Sian Harding, professor emeritus of cardiac pharmacology at Imperial College London, provides compelling examples of the medical facts behind this condition, known as Takotsubo Syndrome, in an article published in Psyche.
We quote some parts of the article:
“Heartbreak is nothing new. For thousands of years, people have written stories, poems and sang songs about the connection between our hearts and our emotions. Even 5,000 years ago, hearts were aching.
As science began to uncover the secrets of the body over time, the source of our emotional pain changed. The brain became the center of emotions and 'heartbreak' was more than just a metaphor. But even as science places emotions deep in the brain, stories about 'broken' hearts still abound: Long-married couples die one after another within days; Parents who died after losing their child, or heart-centered pain during grieving periods. Statistics now confirm this. A spouse is almost twice as likely to die in the first three months after their death.
Cases began in the 1990s after deadly earthquakes. After each disaster, Japanese hospitals were overflowing not only with the injured, but also with people suspected of having a heart attack. The reason for this was unknown until the arrival of heart attack survivors at Hiroshima City Hospital, where doctors used the latest imaging techniques to visualize the coronary arteries that supply blood to the heart muscles.
To determine the cause of a heart attack, cardiologists may inject an opaque contrast solution into the blood vessels and use an X-ray camera to see if a clot or ruptured plaque is causing the blockage. Doctors in Hiroshima followed a new procedure. They injected a contrast solution directly into the heart and recorded moving images to reveal what it looked like when it contracted.
The common point of both diseases is adrenaline. In moments of stress, the body naturally enters a fight-or-flight state where adrenaline stimulates the heart and directs blood to the muscles. However, excessive stress can cause an excessive spike in adrenaline, causing the heart to overwork and disrupt its rhythm.
Takotsubo Syndrome
So how much medical truth is there about 'heartbreak'? This was not a question taken very seriously until an unusual syndrome began to emerge in hospitals in Japan in the 1990s. Doctors saw the hearts of traumatized patients change shape on X-rays. The heart's appearance resembled small clay pots called 'takotsubo' in Japan, used for catching octopus. The story of Takotsubo Syndrome and how it got its name is the story of how heartbreak became more than just a metaphor.
What they saw in some patients surprised and astonished them. First, patients showing all the signs of a typical heart attack did not have any obstruction. Second, the heart was twisting into a shape that doctors in Hiroshima had never seen before. The top of the heart near the atrium contracted so violently that it even blocked blood flow. But the lower part of the heart was almost motionless. In X-rays, it looked like a balloon or a narrow-necked pot. This reminded Japanese doctors of 'takotsubo' used to catch octopus. And so the disease began to be called 'Takotsubo Syndrome' and later 'stress cardiomyopathy'.
As news of the disease spread, similar reports were coming in from all over the world. But the triggers were no longer just earthquakes and other natural disasters. This included grief, trauma, arguments, and even watching sporting events. The loss of a loved one in particular seemed to be a powerful trigger, as the mechanism of our hearts is extremely sensitive to emotional stress. It is this connection with extreme grief that gives the phenomenon a third name: 'Broken Heart Syndrome'.
Certain features made this syndrome stand out for doctors in Hiroshima. The first was that most patients were women, which is unusual as heart disease is more common in men, at least in the young or middle-aged. Men younger than 64 years of age are twice as likely to develop heart disease as women. This difference decreases in life after menopause, and most women with Takotsubo syndrome were in the postmenopausal period. When we put together the numbers of many studies, we found that an astonishing 80-90 percent of patients in the Takotsubo group were women. A condition not seen before in any heart disease.
Even more strikingly, many of these patients recovered completely with no signs of heart damage. Although deaths occurred in 5 percent of all patients, most patients were admitted to the hospital with severe chest pain and acute heart failure, but left the hospital within a few days with recovery.
Many never had any more problems. For scientists and doctors, this was quite interesting. People with severe heart failure often appear weak. If cardiologists had not seen the strange shape and strange contraction of the heart on the X-ray, they might have thought patients were imagining or misinterpreting the symptoms.
It is depressing to think that women with Takotsubo Syndrome may have been overlooked for pretending to be sick before such imaging was possible. You can imagine how a middle-aged woman who came to the hospital with severe chest pain, distraught after a sad event, but then recovered quickly, could be seen as 'hysterical'.”
Sudden cardiac death
The author says Takotsubo Syndrome is not the only 'broken heart' disease: “The other is commonly known as 'sudden cardiac death'. Here the heart enters a chaotic rhythm (or arrhythmia) known as ventricular fibrillation. It resembles a 'sack full of worms' as the different parts of the heart bend instead of contracting together.
The blood is not ejected from the heart and the person loses consciousness within a few minutes. Without manual or electrical defibrillation intervention, rapid death will occur. It has exactly the same triggers as Takotsubo Syndrome, including sudden cardiac death, loss, arguments, and other extreme physical or emotional stress. But with one big difference: It's primarily a male disease, at least for those younger than 50.
A notable event in 2014 revealed the different responses of men and women to extreme stress. Husband and wife, ardent Chilean fans, and their three children were watching the match between Chile and Brazil to advance to the next round at the FIFA 2014 World Cup. The match went to penalties. However, the final and decisive shot hit the goalpost, ending Chile's hopes. The family immediately got into a heated argument, and the 58-year-old father clutched his chest in excruciating pain. His heart stopped and he was taken to the emergency room, although he underwent two rounds of defibrillation, he unfortunately did not survive.
Then his 64-year-old wife felt chest pains. A short time later, she was undergoing treatment in the angiography laboratory where her husband had been an hour earlier. Her heart was showing the same electrical signals as her husband's, but she was not in ventricular fibrillation. Doctors also found no sign of obstruction.
Instead, his heart contracted strongly in one area and nearly immobile in another: It was an obvious case of Takotsubo Syndrome. After a period of supportive care in the hospital, her heart gradually returned to normal and she was discharged after she had fully recovered.
Why are men more prone to adrenaline-induced arrhythmias?
At this point, stress factors are important. The football match was the main trigger for the first and husband. The controversy also created additional possible triggers. Watching football, and sports in general, is often associated with cardiac events. A study reveals that death rates from heart attacks and strokes increase when a local team plays in the home. Penalty shootouts are a particularly important source of stress in football matches.
When England lost to Argentina on penalties on 30 June 1998, myocardial infarction in England had increased by 25 percent for two days. However, in the case of the Chilean woman whose husband died in 2014, the stress of seeing her husband have a heart attack was another strong trigger, especially immediately after the penalty shootout and the ensuing argument. For her husband, the extreme stress of both the match and the argument had caused a fatal arrhythmia. Although he had similar feelings, his wife did not have arrhythmia. Scientists think, paradoxically, that most likely Takotsubo Syndrome precedes any arrhythmia.”
The author states that scientific experiments in his lab have shown that the changes in the heart in Takotsubo Syndrome are the result of high adrenaline levels that normally stimulate the heart (and potentially disrupt its rhythm) but reduce its function: -and fatally- triggered. Takotsubo Syndrome was protecting the heart from something worse by damping or 'shutting down' it: sudden cardiac death.
So why are men more prone to adrenaline-induced arrhythmias? Perhaps a better question is why women are better protected from adrenaline? My hunch is that without this protection, the extreme physical and emotional stress of childbirth can overwhelm mothers with adrenaline. Perhaps this is why young women are protected from both sudden cardiac death and Takotsubo Syndrome. Although women seem to have lost some of this protection after menopause, they still have survived the worst consequences of an adrenaline surge. While there are deaths, many survive the fatal arrhythmia.
Heartbreak may not be new, but he now has a medical history. Experiencing the emotional pain of natural disasters, grief, trauma, arguments, and even sporting events can have very real physical consequences for our health and survival. We can truly be 'heartbroken'. But the story of Takotsubo Syndrome is not just the story of how heartbreak became more than just a metaphor. It is also a retelling of an old, familiar story in which the heart is fundamentally connected with our emotions, a story about how emotions rule over life and death.
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