When emotions take over the heart

“The trigger may be emotional or physical stress,” says Sarah Hugelshofer, cardiologist with the CHUV’s Cardiology Service. Most emotional cases occur after a sudden shock, such as news of a death, but also in happy situations, like winning the lottery. Half of all cases involve physical stress and are triggered by intense physical activity that the person is unprepared for, severe pain or neurological conditions, such as or epileptic seizures. A history of psychiatric disorders such as anxiety and depression increase a person’s predisposition to the syndrome. Hereditary factors probably play a role, as several cases can exist in some families.

It affects a ratio of nine women to one man. Takotsubo cardiomyopathy is more prevalent in women as they approach menopause, suggesting a link with the decline in oestrogen levels. “These hormones are known for their role in protecting against cardiovascular disease, but their connection with the syndrome is not clearly understood, nor are the factors that determine the course of the disease,” the cardiologist explains.

RULING OUT A HEART ATTACK

The symptoms, however, are more familiar, resembling those of a heart attack: chest pain, shortness of breath and fainting. Unfortunately, they cannot be immediately distinguished because “the initial electrocardiograms look the same, as do the cardiac blood markers,” Sarah Hugelshofer says. However, a coronary angiography can accurately diagnose whether the event is in fact a myocardial infarction. Any partial or complete obstruction in the coronary arteries, which can cause a heart attack, will show up using this invasive X-ray imaging technique. “If there is no visible occlusion, we look for something else, such as myocardial inflammation or takotsubo. An ultrasound and often an MRI of the heart are then performed to determine the final diagnosis.”

As the arterial occlusion triggering the heart attack causes heart muscle cells to die and, in severe cases, leads to death of the patient, blood flow must urgently be restored. With broken heart syndrome, hospitalisation, cardiac monitoring and medication are needed. “It is therefore crucial to distinguish between the two conditions using coronary imaging,” the cardiologist explains.