Stress Connected to ‘Broken Heart’


Heightened activity in the brain, caused by stressful events, is linked to the risk of developing a rare and sometimes fatal heart condition, according to research published in the European Heart Journal.

The study found the greater the activity in nerve cells in the amygdala region of the brain, the sooner the condition known as Takotsubo syndrome (TTS) can develop.

The researchers suggest that interventions to lower this stress-related brain activity could help to reduce the risk of developing TTS; these could include drug treatments or techniques for lowering stress.

TTS, also known as “broken heart” syndrome, is characterized by a sudden temporary weakening of the heart muscles. This causes the left ventricle of the heart to balloon out at the bottom while the neck remains narrow, creating a shape resembling a Japanese octopus trap, from which it gets its name.

This relatively rare condition was first described in 1990. Evidence has suggested that it is typically triggered by episodes of severe emotional distress.

Patients develop chest pains and breathlessness, and it can lead to heart attacks and death.

TTS is more common in women with only 10% of cases occurring in men.*

The amygdala is the part of the brain that controls emotions, motivation, learning, and memory. It is also involved in the control of the autonomic nervous system and regulating heart function.

“The study suggests that the increased stress-associated neurobiological activity in the amygdala, which is present years before TTS occurs, may play an important role in its development and may predict the timing of the syndrome.

Together, the findings provide insights into a potential mechanism that may contribute to the ‘heart-brain connection’.”

Dr Tawakol said: “Areas of the brain that have higher metabolic activity tend to be in greater use.

Hence, higher activity in the stress-associated tissues of the brain suggests that the individual has a more active response to stress.

The researchers found that people who went on to develop TTS had higher stress-related amygdalar activity on initial scanning ;(measured as a ratio of amygdalar activity to the activity of brain regions that counter stress) compared to individuals who did not subsequently develop TTS.

The higher the amygdalar signal, the greater the risk of developing TTS.

Among the 41 patients who developed TTS, the average interval between the scan and TTS was 0.9 months, whereas, among the control group of 63 patients, the average interval between the scan and last follow-up or death was 2.9 years.

“It was notable that among the 41 patients who developed TTS, the top 15% with the very highest amygdalar activity developed TTS within a year of imaging. Those with less elevated activity developed TTS several years later,” said Dr Tawakol.

He said future studies should investigate whether reducing stress-related brain activity could decrease the chances of TTS recurring among patients who have experienced TTS previously.

“These findings add to evidence of the adverse effect of stress-related biology on the cardiovascular system.

The process by which stress induces TTS is not well understood. It may involve a multi-organ mechanism; starting with the activation of the stress-sensitive tissues of the brain. This brain activity triggers several further events, including the release of stress hormones, activation of the sympathetic nervous system, and release of inflammatory cells, each of which can contribute to the development of TTS.

Limitations of the study include that it was a single-center, retrospective study that consisted mainly of patients with a diagnosis of cancer, a known TTS risk factor, which may limit the generalizability of the findings.

* TTS affects less than 3% of people who suffer a heart attack and tends to occur between the ages of 60-75.

Stress-associated neurobiological activity associates with the risk for and timing of subsequent Takotsubo syndrome. European Heart Journal, 2021; DOI: 10.1093/eurheartj/ehab029


Node Smith, ND, is a naturopathic physician in Humboldt, Saskatchewan, and associate editor and continuing education director for NDNR. His mission is serving relationships that support the process of transformation, and that ultimately lead to healthier people, businesses, and communities. He has helped found the non-profit, Association for Naturopathic Revitalization (ANR), which works to promote and facilitate experiential education in vitalism.

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