Women more prone to broken heart syndrome

Women, especially above the age of 50, make up nearly 90 per cent of all those affected by broken heart syndrome, suggest studies in the US.

Also termed stress cardiomyopathy or takotsubo (TTS) cardiomyopathy, broken heart syndrome is a silent heart-attack-like event caused by a sudden physical or emotional stress, said Dr Pradeep Kumar D, senior consultant, interventional cardiology, Aster CMI Hospital, Bengaluru. It can begin within minutes or even hours after such an event.

“Ninety per cent of patients affected with stress cardiomyopathy are women (most of them are post-menopausal),” said Dr Kumar. “The exact cause for this is poorly understood. It is postulated that the hormonal changes in the post-menopausal state and increased incidence of depression among women may lead to higher surges in catecholamines (adrenaline), which leads to stress cardiomyopathy.”

He said broken heart syndrome was quite common after extremely stressful situations. “Research suggests that women older than 55 are 2.9 times more likely to develop broken heart syndrome than younger women,” he says. “Hormonal differences between the sexes and variations in coronary arteries may be factors. Stress is another factor that affects women [more] as compared to men, especially after menopause.”

A 2001 study, ‘Sex‐ and Age‐Based Temporal Trends in Takotsubo Syndrome Incidence in the United States’, conducted by Journal of the American Heart Association identified 135,463 documented cases of TTS. “The annual incidence increased steadily in both sexes, with women contributing in most cases (88.3 per cent), especially those aged ≥50 years,” it said.

Like a heart attack but…

“The condition often mimics the symptoms of a heart attack and people sometimes misunderstood it as having a real heart attack,” Dr Kumar said. “It causes weakening of the heart’s main chamber, the left ventricle [and] the chamber that pumps oxygenated blood to the body, causing the bottom of the heart to stop beating and the top of the heart to beat more.”

Dr Deepak Krishnamurthy, senior interventional cardiologist, Sakra World Hospital, Bengaluru, said patients might have a sudden chest pain or think they were having a heart attack. “Broken heart syndrome affects just part of the heart, temporarily disrupting the heart’s usual pumping function,” he said. “The rest of the heart continues to work properly or may even squeeze (contract) more forcefully. The symptoms of broken heart syndrome are treatable. Broken heart syndrome usually reverses itself in days or weeks. Heart attacks are generally caused by a complete or near complete blockage of a heart artery. In broken heart syndrome, the heart arteries are not blocked, although blood flow in the arteries of the heart may be reduced.”

He said the exact cause of broken heart syndrome in women was unclear but it was thought that a surge of stress hormones, such as adrenaline, might temporarily damage the heart of some people. “How these hormones might hurt the heart or whether something else is responsible isn’t completely clear,” Dr Krishnamurthy said. “Broken heart syndrome is often preceded by an intense physical or emotional event — for example, an acute illness (such as an asthma attack or Covid-19 infection). Major surgery or a broken bone can lead to broken heart syndrome. Anything that causes a strong emotional response — such as a death or other loss, or a strong argument — may trigger this condition.”

Dr Krishnamurthy said post-menopausal women tended to be more vulnerable to this condition. Though the underlying reasons are not fully known, it is believed that because the female hormone estrogen helps to protect the heart from the harmful effects of adrenaline, women become particularly vulnerable to the effects of sudden stress as they grow older, and their estrogen levels decline. Other risk factors for developing this condition include a history of anxiety, depression or neurologic illness.
Dr Kumar said that even though the symptoms were temporary and it was rare to develop severe complications, people could still experience blockage and rupture of left ventricle, heart failure, cardiogenic shock (a condition where the heart suddenly stops pumping enough oxygen-rich blood to your body), atrioventricular block and even death.

Symptoms of broken heart syndrome

Dr Krishnamurthy said the most common signs and symptoms of broken heart syndrome were angina (chest pain) and shortness of breath. You can experience these things even if you have no history of heart disease. Arrhythmias (irregular heartbeats) or cardiogenic shock also may occur with broken heart syndrome. Cardiogenic shock — a condition in which a suddenly weakened heart can’t pump enough blood to meet the body’s needs — can be fatal if it isn’t treated right away.

Dr Krishnamurthy suggested a few tips for prevention:

• Diet and exercise: The American Heart Association recommends maintaining a healthy, balanced diet, and getting regular moderate exercise to help prevent heart disease at any age
• Healthy relationships: Maintaining healthy relationships can lead to greater happiness and reduced stress. The 2021 Harvard Study of Adult Development — ‘Coherence Between Feelings and Heart Rate: Links to Early Adversity and Responses to Stress’ — suggests that relationships are key to health and longevity, and broken heart syndrome shows how brain stress is connected to heart stress. “Brain health is connected to heart health over the longer term,” said Dr Krishnamurthy.
• Stress management: Dr Krishnamurthy said managing stress through exercise, mindfulness or simply doing things that you enjoy or having outlets for your stresses would help decrease the occurrence of stress-induced cardiomyopathy or other stress-induced health conditions.