Usually ‘having a broken heart’ is a turn of phrase. Someone might even refer to having ‘heartache’ when they are sad or grief-stricken. But there is a medical condition known as Takotsubo cardiomyopathy or ‘Broken Heart Syndrome’ that is all too real for some people in the UK.
Although there were historical mysteries and sudden, unexplained deaths from traumatic, emotional events, the first medically described cases of Takotsubo were only reported in the 1990s, mostly in Japan. Cases involved people being rushed to hospital after the death of loved ones with seemingly dramatic changes in their hearts.
Takotsubo cardiomyopathy occurs when one of the heart’s chamber, the left ventricle, suddenly expands and weakens. This means that the heart can’t pump blood around the body properly and this extra stress can lead to heart failure.
The condition is still relatively rare and affects predominantly women. However, we are starting to learn more about it and scientists believe the phenomenon occurs as a reaction to a surge of adrenaline to the heart after extreme emotional or physical stress, although there are some cases with no known trigger.
Speaking to the BHF in 2017, Dr Dana Dawson from the University of Aberdeen, funded by the BHF, explained that when she and her team began to really investigate the condition, they came across more and more cases. One woman, for example, developed it simply after a heated argument with her daughter. They realized that insufficient awareness and understanding of the condition were the first hurdles to effective diagnosis.
How do you know if someone has Takotsubo?
On first appearance, someone with Takotsubo might look like they are having a heart attack, even to a doctor. The symptoms, electrocardiogram (ECG) and even the blood tests, of someone experiencing Takotsubo can appear the same as someone who is having a heart attack. However, this paints a misleading picture: Takotsubo cardiomyopathy and a heart attack are two very different conditions.
BHF Professor Michael Davies discovered that most heart attacks are caused by a blood clot in the coronary artery in the 1970s, but we didn’t always know this. In the same way, Dr Dawson’s team soon realised that to understand why someone has developed Takotsubo syndrome, we would need to have a fuller picture of what is going on inside their hearts, and maybe even their heads. Takotsubo is so unusual because of the way in which emotional trauma is so acutely reflected in a physical response.
Dr Dawson has said that her team’s ultimate goal is to find a ‘signature’ — a telltale sign for Takotsubo so that doctors can diagnose people accurately and get them the most appropriate treatment. In 2011, her team set up the first Takotsubo follow-up clinic in the NHS to see exactly what happens to people after their heart attack.
Past studies suggested that the heart bounces back and recovers quickly after Takotsubo, but Dr Dawson’s team found that this wasn’t the case. Most people had only partially recovered after four months, some were extremely tired many months later, while others were breathless or had unexplained chest pains.
Their work began to challenge all previous understanding of what goes on while a person is experiencing Takotsubo and, crucially, what happens in the aftermath. As a result, they set up the HEROIC study, part-funded by the BHF, looking at patients who developed Takotsubo syndrome over a year ago, to see what they could learn about how the heart recovers — or doesn’t.
The team started a national Takotsubo Registry, funded by the Chief Scientist Office (CSO) Scotland, to look at epidemiology how common the condition is, possible causes and effects) of Takotsubo in Scotland. At the moment, it’s difficult to gauge the how many people have had the condition as it has only recently been properly differentiated from a heart attack. The eventual goal is to know as much about Takotsubo as we do about heart attacks.
How can you treat Takotsubo?
The short answer is that you can’t. There are no known treatments to help in the early stages of Takotsubo syndrome, or to prevent it from happening again. As we know, Takotsubo is not the same as a heart attack and so applying the same treatment methods does not work.
Dr Dawson’s team have, however, discovered that in broken heart syndrome, the heart muscle is persistently swollen and there is inflammation in the heart and the body. Her team is currently working on a project to find out if inflammation is the key mechanism driving the ‘broken heart’ and preventing recovery.
They are looking at how, and across what kind of timescale, this inflammation develops. Scientists are using magnetic resonance imaging (MRI) scans to detect inflammation in the heart and will study whether the chronic symptoms of broken heart syndrome are due to this inflammatory response. Finding out more about what happens during Takotsubo syndrome is key to developing effective treatment.
Could energy by the key?
Dr Dawson’s team have also discovered that the heart cells of people with Takotsubo cannot produce energy efficiently. In a new study, they will work with rats that have developed a disease that mimics the energy problem seen in humans to test the effects of a drug called trimetazidine. Trimetazidine changes the way that energy is generated in heart cells from fat breakdown to sugar breakdown. Dr Dawson believes that fat breakdown could be harmful in Takotsubo, , whereas sugar breakdown could produce energy more rapidly.
By finding out if trimetazidine can restore energy production in an animal model of broken heart syndrome, this research could provide the scientific basis for a clinical trial to test this strategy in patients.
The final avenue of investigation will look at whether the heart health of people with Takotsubo can be improved through prescribed physical activity or psychological interventions. Volunteers who’ve had a recent episode of broken heart syndrome will be prescribed either a three-month schedule of exercise or mental wellbeing training. The team want to know if either course of treatment helps people with Takotsubo to recover, and how this compares to those undergoing ‘normal’ follow up care.
Much remains to be known about this unusual condition, as Dr Dawson explains: “There is a lot more to find out. We will also try to determine if individuals who develop Takotsubo may be predisposed. It’s fascinating research; this is the strongest interaction [where mental state affects physical health] that we know of in medicine.”
If you liked this, you might like:
- A fishy clue to heart regeneration
- The heart — what treatments are we funding to help mend broken hearts?
- Standing on the Shoulders of Science Fiction
And follow the BHF publication on Medium to keep up-to-date with research that keeps hearts beating and blood pumping: