March 16, 2016
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Positive emotional stress plays role in takotsubo syndrome

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Takotsubo syndrome can be triggered by both positive and negative emotional stressors, researchers reported in the European Heart Journal.

“We have shown that the triggers for [takotsubo syndrome] can be more varied than previously thought. A [takotsubo syndrome] patient is no longer the classic ‘broken-hearted’ patient, and the disease can be preceded by positive emotions too,” Jelena Ghadri, MD, resident cardiologist at the University Hospital Zurich in Switzerland, said in a press release

Ghadri and colleagues analyzed data from 1,750 patients enrolled in the International Takotsubo Registry and identified 485 patients whose takotsubo syndrome episode was preceded by an emotional event. Patients in the registry were drawn from the University Hospital Zurich in Switzerland, as well as centers in Austria, Finland, France, Germany, Italy, Poland, Switzerland, the United Kingdom and the United States.

The researchers divided the 485 patients into two groups — “happy hearts” (n = 20) and “broken hearts” (n = 465) — to signify whether the preceding event was a positive or negative one. Patients in both groups were predominately women (P < .001) and most were either unemployed or retired at the time of the episode (P = .018). Those in the happy hearts group were older than those in the broken hearts group (71.4 11.2 years vs. 65 12.5 years; P = .026).

Ghadri and colleagues observed that those in the happy hearts group were more likely to have atrioventricular block (15% vs. 3.9%; P = .052) and the midventricular type of takotsubo syndrome (35% vs. 16.3%; P =.03), but not apical ballooning pattern (65% vs. 79.8%). The researchers found no significant differences in clinical care or patient outcomes between the two groups.

Ghadri said their findings “suggest that happy and sad life events may share similar emotional pathways that can, ultimately, cause [takotsubo syndrome].”

Clinicians should “consider that patients who arrive in the [ED] with signs of [MI], such as chest pain and breathlessness, but after a happy event or emotion, could be suffering from [takotsubo syndrome] just as much as a similar patient presenting after a negative emotional event,” she said.

Christian Templin, MD, a consultant cardiologist at University Hospital Zurich who also contributed to the study, called for future research to understand the mechanisms behind these different triggers.

“We believe that [takotsubo syndrome] is a classic example of an intertwined feedback mechanism, involving the psychological and/or physical stimuli, the brain and the [CV] system. Perhaps both happy and sad life events, while inherently distinct, share final common pathways in the central nervous system output, which ultimately lead to [takotsubo cardiomyopathy syndrome],” he said in the release. – by Tracey Romero

Disclosure: The researchers report no relevant financial disclosures.