In the first ever study of its kind, Aberdeen researchers exploring ‘broken-heart syndrome’ have revealed that patients are being failed by current treatments.

Takotsubo cardiomyopathy can be triggered by extreme emotional distress, leading to its nickname ‘broken-heart syndrome’.

Researchers have now found that patients who had suffered from takotsubo were not receiving effective treatment and were more likely to die than the general population.

Using Public Health Scotland figures, the Aberdeen team compared patients diagnosed with takotsubo and those who suffered from a heart attack and the general population over five years.

Led by the University of Aberdeen’s Professor Dana Dawson, the study also revealed that broken-heart syndrome patients are just as vulnerable to dying as those who suffer a ‘true’ heart attack.

Currently, there is no consensus among experts about how to treat patients with broken-heart syndrome and so they are commonly treated like other heart conditions.

Researchers found that the heart medications prescribed to ‘broken-hearted’ patients following their diagnosis of takotsubo is ineffective.

They say the medications did not improve the survival rate of takotsubo patients.

Unique findings

Analysing data from 3,720 patients, Professor Dawson says the team were surprised by the treatments broken-hearted patients receive across Scotland:

“We were surprised to see that when compared to patients with ‘classical heart attacks’ – they were medicated in the same way.

“We looked at 10 different categories of medicines and they were prescribed at the same rate – this was true for both typical heart medications and non-cardiovascular medications like HRT and anti-inflammatory medications.  

“Our findings are truly unique as we are able to look at follow-up prescriptions over a prolonged period of time with world-leading accuracy using the Public Health Scotland database.  

“Our data shows quite starkly that we are not treating this condition correctly.”

Professor Dawson explains that the condition involves distress in the brain causing strain on the heart.

She says there is an increasing understanding of the different factors underpinning to takotsubo:

“Understanding is growing and there is evidence that it can be caused by other factors, including physical trauma or no incident at all.

“Takotsubo cardiomyopathy happens when one of the heart’s chambers, the left ventricle, suddenly balloons and weakens. The heart then can’t pump blood around the body as before and the extra stress leads to heart failure.

“Symptoms can appear like a heart attack including shortness of breath and chest pain.”

Despite similar symptoms, broken-heart syndrome is a “different condition entirely” from a heart attack, particularly as patients do not experience a blockage of their arteries.

Professor Dawson adds that with increased mortality and vulnerability to developing other heart conditions, it is “vital” to find precise ways to treat the ‘broken-hearted’ population.

Dr Sonya Babu-Narayan, Associate Medical Director at the British Heart Foundation, says this work also reveals the greater prevalence of the condition among women and calls for more research:

“These data from Scotland show that the diagnosis of takotsubo, a condition more common for women, is linked to a higher chance of death in the long term.

“More research into takotsubo could better reveal its causes and which treatments could save and improve lives.”

A “neglected” area of cardiology

A former journalist and current communications adviser, Michelle Canning, was diagnosed with the condition in January 2021, following the loss of her father.

Michelle initially dismissed her symptoms as indigestion but after hearing them at a routine appointment, her GP conducted an ECG and directed Michelle to hospital.

A mum-of-three, non-smoker and regularly exercises, she was surprised to find herself admitted to hospital with a suspected heart attack.

An angiogram then revealed that her arteries were clear, with no coronary damage to her heart.

Instead, she was diagnosed with takotsubo, likely triggered by the sudden death of her father.

Describing herself as “emotionally resilient”, Michelle says it was a shock to realise stress was presenting itself physically.

Michelle says that while she had “amazing care”, she left hospital feeling unsure of the future or if it might happen again:

“There is a need for more research, so I am delighted to see this work from Professor Dawson and her team.

“Broken-heart syndrome is probably one of the most neglected areas of cardiology. I don’t think it is any surprise that this is a condition that mostly affects women.”

Professor Dawson says the Aberdeen team are planning to investigate the most effective way to treat this “unique group of people” as they continue their research into broken-heart syndrome.

While researchers say they identified one drug as a “potential breakthrough” with promising therapeutic benefit, she says more research is needed to establish if this is the “key to treating this devastating illness.”

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