Veterinary nurse Sarah Woodward was at work when she got a call that her best friend’s father had died.
Sarah of Worthing, West Sussex, says, ‘I have known him for 45 years. ‘It was like losing my own father.’
Before she could put down the phone, the stabbing pains started in her chest. It then spread through his back, into his jaw and down his left arm.
He began struggling to breathe and turned chalky—all classic signs of a heart attack.
54-year-old Sarah, however, was exceptionally fit, exercising at least ten hours a week, including kickboxing. She didn’t smoke, cooked from scratch every day with husband Kevin, 58, and drank only once a week.
Veterinary nurse Sarah Woodward was at work when she got a call that her best friend’s father had died. Sarah of Worthing, West Sussex, says, ‘I have known him for 45 years. ‘It was like losing my own father’
That’s why it never came to his mind that he was having a heart attack. Instead, he thought it was just a panic attack or that he had pulled a muscle while exercising.
However, a colleague called an ambulance and a few hours later, tests showed it was something else entirely. Sarah had rupture heart syndrome (medically known as Takotsubo cardiomyopathy or Takotsubo syndrome) – where there is a sudden weakening of the muscles in the heart’s left ventricle, its main pumping chamber.
The mysterious and potentially fatal condition affects about 2,500 Britons a year and is often followed by bereavement, hence its name.
About 90 percent of patients are women age 50 or older, and about one in 20 will result in a hospital death.
In survivors, heart shape and pumping ability usually return to normal within three months, but many develop long-term problems, including chest pain, palpitations, and breathlessness.
While symptoms such as sudden intense chest pain and shortness of breath are typical of a heart attack, takotsubo is not caused by blocked arteries—as are usually the case with heart attacks.
Instead, says Dr David Gamble, Clinical Research Fellow in Cardiology at the University of Aberdeen, a stressful event is to blame in about 70 percent of cases (in other cases, the cause is unclear).
It can be emotional, such as the death of a loved one or the end of a relationship, or physical, such as an assault or car accident.
Interestingly, the stress need not be negative; Happy occasions can also wake up the situation. A 2016 study by the University Hospital Zurich in Switzerland on 485 patients who had an emotional trigger in takotsubo found that 96 percent had experienced tragic events, with the remaining 4 percent, following a joyous occasion. happened, such as a birthday party, winning at a casino or even a surprise marriage proposal.
It never crossed his mind that he was having a heart attack. Instead, he thought it was just a panic attack or that he pulled a muscle while exercising.
This is because all of these events – and the stress response they trigger in the body – lead to a surge in adrenaline, a hormone that is released to prepare the body for ‘fight or flight’ that regulates blood flow to the brain. Tells the heart to beat faster to give a boost. and muscles.
However, in Takotsubo syndrome, the adrenaline rush shuts off the lower part of the left ventricle, its main pumping chamber, says cardiologist Dr Alexander Lyon, Honorary Consultant Cardiologist at the Royal Brompton Hospital in London. Unable to contract, the bottom of the ventricle balloons outwards.
This distinctive shape is visible on an X-ray of the heart and is important in diagnosing the syndrome. This is why in 1990 Japanese researchers named it after ‘takotsubo’ – a traditional narrow-necked, wide-bottomed vessel used to trap octopuses while fishing.
A mystery for doctors seeing affected people is understanding why this rush of adrenaline affects some people, especially women, but not others.
Now scientists may have an answer that could pave the way for better treatments for the condition. In a study published in June in the journal Cardiovascular Research, Dr Lyon and colleagues from Imperial College London examined how human and rat heart cells responded to adrenaline.
They found that heart cells were more sensitive to adrenaline if they were exposed to two molecules, microRNA-16 and microRNA-26a. Of those, it took only one-fifth of the normal amount of adrenaline to stop contracting.
MicroRNAs are small compounds that control protein production in cells. It is not known where these two originate, but one theory is that they are released by the brain in times of depression, anxiety, and stress and travel in the blood to the heart.
Chronic stress can raise levels to such an extent that some people are more likely to have a takotsubo attack after a sudden shock.
Put another way, if two people experience the same rush of adrenaline after a stroke, the person who has higher amounts of these microRNAs in their blood will be more likely to have a takotsubo attack, says Sean Harding, Cardiac. says a professor of pharmacology. the study.
“It may be that chronic stress is predisposing people to this syndrome when they suffer from acute stress,” she adds.
A study from Massachusetts General Hospital in March supports this theory. It found that patients undergoing cancer scans that displayed higher activity in their amygdalas (the part of the brain that detects stress) were more likely to have broken heart syndrome over the next five years.
Gamble says that depression, anxiety, and other mental health disorders are more common in people who experience Takotsubo syndrome, and he is researching whether cognitive behavioral therapy (CBT) — a talking tool that improves mental health. Therapy – will aid recovery.
Thirty patients will undergo 12 weeks of CBT and have greater heart health than patients who have been prescribed either a 12-week exercise program (exercise lowers cholesterol, blood pressure and improves blood sugar regulation). is) or treated only with standard care.
Little is known about the best treatment for the syndrome, but there is some evidence that ACE inhibitors, medications prescribed to treat high blood pressure, are useful.
Genes and hormones may also play a role – genes, because the condition can run in families, and hormones because most cases occur in post-menopausal women.
It is thought that male and female sex hormones may protect against the condition, making women more vulnerable after menopause, when estrogen levels are low. The higher levels of stress and anxiety in post-menopausal women may also help explain the link, says Gamble.
One possibility in the future could be a test that measures the levels of two microRNAs, identified in a recent Imperial study, to predict whether a patient is at risk of experiencing a second attack of broken heart syndrome.
Similarly, drugs that block the action of the two microRNAs may provide a much needed way of preventing recurrence.
About one in five broken heart patients have a recurrence – and Sarah was one of them. After her first takotsubo attack she was prescribed ACE inhibitors, beta blockers (blood pressure drugs that block the effects of adrenaline), as well as blood thinners to reduce the risk of clots, which could lead to stroke could.
But on January 4, 2021, nearly three years after she fell at work, she felt the same stabbing pain in her chest.
The trigger was a call from her GP in which she gave her some disturbing news about another, unrelated, health condition.
‘I remember sitting in the staff room, clutching my chest, crying and thinking I was going to die looking at the waste-paper box that was overflowing. It was a feeling of complete resignation and despair,’ says Sara, who has three grown children.
Eight months later, she still has chest pain and shortness of breath and when she goes to the gym, she needs to take naps earlier and there is no question of intense workouts.
There is fear in the back of his mind that he will have another attack. ‘The more I think about it, the more I worry that the third time might be the last,’ she says.
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