Column: Dr Tawakol On Heart, Stress & More
[Contributed by Dr Ahmed Tawakol]
According to the Bermuda Heart Foundation, heart disease is a leading cause of death in Bermuda – backed up by the 2017 Health in Review, put out by the Government of Bermuda. This underscores the critical need for heart health awareness, especially during Heart Month.
While it’s not as common as many forms of heart disease, one of those that elicits the most curiosity is Broken Heart Syndrome. Also known, less romantically, as Takotsubo Syndrome, it is a heart failure condition that develops suddenly after a physically or emotionally stressful event. The classical triggers include extreme emotional stressors –such as the name suggests, the loss of a loved one. It can also be triggered by the stress of a serious physical illness but in a third of patients, no trigger is found.
Broken Heart Syndrome is seen in approximately two to three percent of patients who present with symptoms of a heart attack. The syndrome is more commonly observed among people with a history of anxiety or depression, more often in women than men and in those over the age of 50.
Symptoms can include chest pain and shortness of breath, and patients may also experience palpitations and dizziness – in rare cases, the condition can be fatal. For those keeping score, these symptoms are largely in line with those of a heart attack, but this Syndrome is not caused by blockages of the main coronary arteries. Another unusual detail is that the heart changes shape, with the tip of the heart often found to balloon outward.
The brain plays an important role in the development of Broken Heart Syndrome. The syndrome is more likely to develop in people with high activity in the amygdala [resulting in stress-sensitive brains]. In those with active amygdalae: sudden, severe stress can lead the brain to trigger the narrowing of the heart’s microscopic vessels, causing the heart to malfunction – a brain-heart connection gone awry.
Treatment involves a combination of medications typically used for more common heart failure syndromes. In most cases, particularly in those with emotional triggers, the heart failure syndrome reverses itself.
Beyond Broken Heart Syndrome, stress, depression and anxiety can weigh heavily on heart health. It’s been known for millennia that intense emotional feelings can elicit a heaviness in the chest. We now know that – particularly in those with active brain-heart connections – this chest pain emanates from the heart’s muscles. For example, severe anxiety can lead to the squeezing of the heart’s microscopic arteries, which can rapidly [though fortunately temporarily] throttle the delivery of blood to the heart’s muscles. This triggers the same type of chest pains that people experience when their large coronaries are blocked. While anxiety-provoked pains typically resolve over time, the consequences of these stress-related blood flow disturbances are not benign; they’re associated with an elevated long-term risk of future heart attacks.
To reduce the risk of Broken Heart Syndrome and to make the brain less sensitive to the impacts of stress in general, a healthy lifestyle is encouraged. Stress reduction, increased physical activity, healthy sleep, balanced diets and more time spent with loved ones all contribute to making the brain less likely to trigger an intense or sustained physiological response following stress exposure. These approaches help support a healthier brain-heart connection and build emotional and physical resilience.
- Dr Ahmed Tawakol, Director of Nuclear Cardiology and Co-Director of the Cardiovascular Imaging Research Center at Massachusetts General Hospital
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