IS IT really possible to die from a broken heart? This question often comes up in the press when someone dies suddenly following a bereavement – for example, when . The answer is yes, there is strong evidence to show that extreme and/or sudden emotional stress can have direct and damaging effects on the heart.
Cardiac arrest is caused by severe disturbances to the heart’s rhythm. It can be triggered by highly stressful situations such as bereavement, which has led to the term broken heart syndrome. Arguments and dramatic events like natural disasters and even sporting fixtures can also be the cause. If the heart isn’t shocked back into its correct rhythm, it can be rapidly fatal: this is known as sudden cardiac death.
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sudden cardiac death is most usually seen in men, for reasons that aren’t yet clear. It causes 25 per cent of all deaths from heart disease. But there is a less-well-known condition that is also called broken heart syndrome. This is more common in postmenopausal women (80 to 90 per cent of patients) and has a more hopeful prognosis. Could it be the key to protection from sudden cardiac death?
The first observations of this other condition were in Japan in 1990, after an earthquake. It feels and presents like a heart attack, with chest pain, but, crucially, can be spontaneously reversible. Doctors can find no evidence of a heart attack, but see a temporary loss of function of part of the heart muscle. Japanese clinicians called it takotsubo syndrome, since the peculiar shape of the heart in images reminded them of tako tsubo octopus pots. Bereavement is again a common cause, as are natural disasters.
Up to 5 per cent of people with takotsubo syndrome die within the first few days of the triggering incident, but many people recover heart function quickly with supportive treatment. Yet takotsubo syndrome is very likely to be misdiagnosed, as doctors may miss the heart paralysis unless special imaging is used. The patient, discharged without a diagnosis, is usually confused and anxious. The syndrome recurs in a significant number of people.
The difference between men and women is illustrated by one , in which a Chilean family were watching a football final (a well-known trigger for heart problems). Their team lost to Brazil and a huge family argument arose. The husband collapsed and was taken to hospital, where he sadly died of cardiac arrest. About an hour later, his wife was admitted to the same hospital with cardiac symptoms: she was diagnosed with takotsubo syndrome and discharged a few days later after a full recovery.
My team’s research has shown that very high adrenaline levels can switch the heart into a state of temporary depression of function. When we tried to block this effect in anaesthetised rats, we were surprised to find we would trigger an irregular heart rhythm and sudden cardiac death. Because of , we think that takotsubo syndrome may in fact be a protective mechanism, depressing the heart in the short term in order to prevent a worse outcome.
Why would more women experience takotsubo syndrome than men? The hormone oestrogen may be a key factor, as young women seem to be protected from both types of broken heart syndrome. Older women will have some oestrogen, albeit reduced levels, and we have yet to learn whether trans women with gender-affirming hormone treatment will be protected.
Better recognition of takotsubo syndrome is crucial. But even more important is understanding if and how this protective effect occurs. It could be a path to a new therapy for both types of broken heart syndrome, which would benefit everyone.
Sian Harding is emeritus professor of cardiac pharmacology at Imperial College London and author of The Exquisite Machine
