Journal of Advanced Practice Nursing

New Clues Why Women Get Broken-Heart Syndrome


By Lucette Lagnado

Harmony Reynolds, a cardiologist at NYU Langone Medical Center, recently led a study that subjected 20 women to a host of tests designed to bring on physical and mental stress.

The study looked for possible reasons some of the women had suffered a mysterious ailment known as broken-heart syndrome, which mimics a heart attack but generally doesn’t appear to be due to coronary artery disease.

In seeking a common thread among the 10 women in the group who had experienced an attack of broken-heart syndrome over the past several years, Dr. Reynolds and colleagues came to suspect they each suffered from an impaired parasympathetic nervous system, the part of the nervous system responsible for helping the body calm down.

The study led to strikingly different conclusions from what other researchers had previously believed might be behind the unusual malady. It also led Dr. Reynolds to believe that breathing and other relaxation techniques such as yoga and meditation should be tested for preventing broken-heart syndrome.

Experts say broken-heart syndrome, which most often affects women in their 60s or older, can be brought on by strong emotions, such as grief, anger and anxiety, or by physical stress. A common trigger is a loved one’s illness or death, while for some patients there is no clear-cut cause for an attack. “It is a romantic notion, but you really can get this from heartache,” says Dr. Reynolds.

Roberta Silver, who participated in Dr. Reynolds’s study, recalls driving in Santa Monica, Calif., in 2007 when she suddenly felt her heart pounding. She pulled over to a cafe, where she became intensely ill. An ambulance took her to a hospital, and she was told she had suffered a heart attack. But a series of tests, including an angiogram, all turned up negative, she says.

“I had no blockage, nothing,” recalls Ms. Silver, who was visiting California from her home in New Jersey. After several days in the hospital, doctors concluded she had suffered broken-heart syndrome. Ms. Silver, who is 70, still isn’t sure what caused the event, and she hasn’t had a repeat episode. But she was ill with an upper respiratory infection and under stress at the time: A cousin she had been close to had died and Ms. Silver was planning to attend his funeral in San Francisco. And preparations for her son’s wedding were proving upsetting.

Broken-heart syndrome can at times be brought on by intense joy and excitement. Vera Compagnino, 53, who also participated in the recent study, remembers how elated she felt one October day 10 years ago watching her son playing football. “It was such an exciting game,” recalls Ms. Compagnino, a teacher’s assistant in Staten Island, N.Y. In her exuberance, she began chanting some cheer songs from her high school days and vowed to do a cartwheel if her son’s team scored a touchdown.

Suddenly, Ms. Compagnino started feeling an intense pain in her chest “like an elephant was sitting on me,” she recalled. Yet at the hospital, doctors found nothing on her angiogram that was amiss --- no sign of clogged arteries. She became a patient of Dr. Reynolds, who believes anxiety played a role in bringing on the attack and has tried to guide her in the hope of preventing future episodes.

There were 6,230 cases of people in the U.S. hospitalized with broken-heart syndrome in 2012, according to a recent study. Patients usually heal within days or weeks without residual damage to the heart. But complications can occur, as well as fatalities.

Broken-heart syndrome was first isolated by Japanese researchers 25 years ago, who named the condition takotsubo cardiomyopathy. Takotsubo is a Japanese term which means octopus trap, a reference to the ballooning shape of the heart during an attack.

For years, researchers believed takotsubo was linked to the nervous system, specifically that portion known as the sympathetic nervous system, which at times of stress produces a flow of adrenaline that can overwhelm the heart. Doctors often prescribed beta blockers, a type of medication that works on the sympathetic nervous system to control adrenaline and other hormones.

That treatment is being challenged. A large study published in September, which looked at hundreds of takotsubo patients in a registry of 26 medical centers in Europe and America, concluded that treatment with beta blockers didn’t help. Citing the significant rates of recurrence among those taking the medicines, it said the “data suggest that beta blockers are not effective in preventing takotsubo cardiomyopathy.”

The research by Dr. Reynolds and colleagues considered both sides of the nervous system in the 10 women being studied. “We thought if the sympathetic [system] isn’t the whole story, maybe there is a problem with the parasympathetic,” she said.

The participants were subjected to a host of tests designed to bring on stress, including being asked to describe their initial trauma. The tests were conducted in a quiet, temperature controlled laboratory where the women were closely monitored. Ten other women described as “healthy” were used as controls.

Lucy Norcliffe-Kaufmann, an assistant professor at NYU School of Medicine and a co-investigator on the study, recalls how one of the women “set off alarms” when she started to speak about her takotsubo event. “I saw she was having high blood pressure when she was only recalling the episode. We started asking [all] the women to tell us about their episode…. and each of the women had this response” in their blood pressure, Dr. Kaufmann said.

Even years after their attacks, the study said, the participants had “reduced parasympathetic modulation of heart rate,” meaning that that part of their nervous system didn’t kick in as effectively as it should.

Cardiologists who study takotsubo welcomed the new research. “This is another piece to the puzzle,” says Gregg Fonarow, a professor of medicine at the David Geffen School of Medicine at UCLA and co-chief of its division of cardiology. By focusing on the parasympathetic side of the nervous system, “it is shining a light on a potential explanation for the underlying cause [of takotsubo] and will help foster additional research,” says Dr. Fonarow.

Scott Sharkey, an expert on takotsubo at the Minneapolis Heart Institute, raised questions about the study’s reliance on controls that he contends were less than ideal. Since half the takotsubo patients in the study had hypertension, half the healthy controls should also have had hypertension, because high blood pressure is believed to affect the nervous system, Dr. Sharkey said. Still, the findings “are real and potentially important”—and call for more study, he said.

Dr. Reynolds acknowledged that ideally she should have had controls with hypertension. She says she hopes to build on the study to come up with prevention strategies. Yoga, meditation and guided relaxation, specifically breathing, are high on her list, because “we know that it improves parasympathetic functions,” she says. “We need to enhance the mind-body relationship.”

Clancy McKenna, another participant in Dr. Reynolds’s study who suffered a takotsubo attack in 2009, has been mindful of needing to change her lifestyle. At the time of her attack, she was working as an English teacher in New York City and taking care of her sick mother. Yet the trigger for her attack appeared to be physical. One day she took a different route bicycling to work and found herself going up a hill. “I had to stop, I could not breathe,” she recalls.

Though Ms. McKenna made it to work, she ended up in an emergency room. After a hospital stay, she was referred to Dr. Reynolds, who recommended that Ms. McKenna be more mindful of stressors, including asking other family members for help caring for her mother. The doctor also advised her to consider exercise, meditation and yoga that might help prevent another attack.

“I am in a better place,” says Ms. McKenna, who is 62. She recently retired, bought herself a motor home and has been leisurely traveling around the country. “I am stopping where I want to stop,” she says.


Articles in this issue:

Leave a Comment

Please keep in mind that all comments are moderated. Please do not use a spam keyword or a domain as your name, or else it will be deleted. Let's have a personal and meaningful conversation instead. Thanks for your comments!

Image Captcha