We have all heard of the notion that people can die of a broken heart. To an extent this is true, but it does not have to be from an unhappy event. It can also occur, although these instances are much more rare, in situations brought on by happiness.
According to a recent article published in the European Heart Journal, Takotsubo Cardiomyopathy (or Takotsubo Syndrome TTS), is a relatively new and rare heart condition which was first described in Japan in 1990, with the first reported case occurring in the United States in 1998. Since then it has been increasingly recognized and identified in patients globally.
The name “Takotsubo” is derived from the Japanese ceramic pot that is used to trap octopus. It closely resembles the abnormal shape of the heart on imaging studies. There is an out-pouching, or ballooning, of the heart’s main pumping chamber, the left ventricle.
Often described as the “broken heart syndrome,” TTS was noted to occur in individuals under conditions of extreme emotional duress — such as anger, fear or grief — where there would be an abrupt and unpredictable onset of chest pain and shortness of breath. The adrenaline rush fueled by the sympathetic nervous system (which controls our fright-and-flight response) can cause deadly arrhythmias, TTS and sudden cardiac death.
The condition occurs predominantly in females older than 50 — only 10 percent of cases occur in males. Often, these frightful symptoms may mimic a heart attack (which is precipitated by a blockage of the heart’s blood supply), TTS is not distinguished from a heart attack until imaging studies of the heart (angiograms) fail to reveal severe plaque buildup in the coronary arteries.
Scientists in this study have discovered that it is not negative emotions alone that can trigger this condition, but happy emotions as well. Positive emotions can also trigger the activation of the sympathetic nervous system and the parasympathetic nervous system (associated with “rest and digest” mode). For example, they note that people are 27 percent more likely to experience a cardiovascular event on their birthdays than the rest of the days of the year.
The study population was chosen from the International Takotsubo Registry which was established in Zurich, Switzerland in 2011. Data were collected from Zurich and 25 collaborating centers in nine different countries. Of the 1,750 subjects, 485 had an emotional trigger prior to their TTS event.
Of the 485 subjects, 4.1 percent (n=20) had a happy event precipitate their episode of what the authors dub “happy heart syndrome,” whereas the majority, 95.9 percent (n=465), had “broken heart syndrome.” This is the first time data have demonstrated that TTS is not always caused by negative emotions.
Why is this relevant? The authors mention that it helps direct further research into the role that the central nervous system plays in this disease and other cardiovascular diseases, as well as the brain’s involvement in the processing of emotions.
As clinicians encounter post-menopausal females complaining of symptoms resembling a heart attack, TTS should always be part of the differential diagnosis, regardless of the emotional nature preceding the event.