What is broken heart syndrome? Beware of strong emotions

Roscoe Arbuckle –known to the public as Fatty, Chubby – was an American silent film comic actor, extraordinarily famous in his time and mentor of colleagues such as Buster Keaton, Charlie Chaplin and Bob Hope. With millionaire contracts in Hollywood and at the top of his career, Arbuckle was accused of the rape and death of the young actress Virginia Rappe during a private party. The case was built on statements to the tabloid press and the police by a friend of the actress who had previously tried to extort money from the comedian.

Although the actor’s complete innocence was finally proven – including an unprecedented apology by the court that judged him – the media scandal of the judicial process destroyed his career and plunged him into depression and alcohol. His friend Keaton – who was always by his side – managed to get the Warner studio to give him a new opportunity, but an hour after signing his brand-new contract, the wheel of fortune turned again and the hapless Arbuckle died of a heart attack. Paradoxical? From the human point of view, certainly, but from biology, not at all.

A heart shaped octopus trap

On many occasions, surprises – happy or sad – can significantly affect the heart, producing heart disease whose symptoms overlap with those of an acute myocardial infarction. It is called broken heart syndrome or takotsubo cardiomyopathy. This curious name derives from the Japanese word for octopus trapsince the left ventricle of the heart is deformed, acquiring the shape of this traditional fishing art.

The disease was not scientifically described until 1991 in Japan and constitutes a paradigm of the interaction between emotions, the brain and the rest of the organism. Triggers are varied and include strong impressions such as a surprise birthday party, a child’s wedding, winning the lottery, the birth of a grandchild, a total loss car accident, loss of job or savings, and The death of a loved one. It can also appear after surgical interventions or as a side effect of some drug treatments.

Symptoms consistent with those of a heart attack

The clinical picture is similar to that of an acute myocardial infarction, with severe chest pain and labored breathing and cardiac arrhythmia. In addition, clinical tests such as electrocardiogram and blood biomarkers reveal a pattern consistent with a conventional heart attack. However, catheterization does not find any blockage of the coronary arteries.

The current consensus in the medical community indicates that the physiological basis is determined by a sudden rise in adrenaline due to hyperactivation of the sympathetic nervous system, which mediates fight or flight reactions. The deformation of the heart during this pathology seems to be determined by the differences in the expression of adrenaline receptors throughout the left ventricle.

few serious cases

Fortunately, broken heart syndrome does not do justice to its name and the rate of serious complications is relatively low in the absence of comorbidities (presence of other disorders), and no specific treatment is necessary.

The injury to the heart is transient, and the heart heals virtually on its own within a few weeks. Although some studies suggest that there is a small injury to the heart muscle that in the long term could cause other problems.

This syndrome has an incidence of 0.02% of hospital admissions, which for Spain, for example, represents around 80,000 cases per year. It appears mainly in women –90% of cases– and has also been linked to low estrogen levels after menopause. In addition to hormonal factors, genetic predisposition and previous psychiatric problems seem to influence the appearance of this syndrome.

Although there is still a long way to go to predict which people are more likely to develop it, a recent study has found significant differences in the interconnection patterns of the brain between people who have suffered from broken heart syndrome compared to healthy controls of the same sex and age . This could open the way to predictive knowledge and its possible preventive treatment.

In any case, I would dare to say that the Stoics are completely protected against this syndrome. Perhaps the preventive treatment consists of rereading Seneca or Marcus Aurelius.

Antonio José Caruz Arcos, Professor of Genetics, Jaen University

This article was originally published on The Conversation. Read the original.