During the Christmas holidays, Rachel and her son were arguing over Brexit after she, a staunch Remainer, had just discovered that he had voted to leave the EU. Feeling unnerved, and with an intense dislike of confrontation, Rachel decided to go for a walk in order to calm down. However, as she got up to leave she developed severe chest pain and fell to the floor, gasping for breath. Her son called for an ambulance, thinking she was having a heart attack. Paramedics came to the same conclusion and, like the majority of people with this serious illness, Rachel underwent emergency coronary angiography – an invasive test used to visualise the coronary arteries and open up the blockages that cause heart attacks.
Her coronary arteries were completely normal, despite her symptoms. Rachel had in fact developed a condition called “Takotsubo cardiomyopathy”, also known as “broken heart syndrome”. Its chief characteristic is a “ballooning” of the tip of the left ventricle – the main pumping chamber of the heart – causing it to resemble the Japanese octopus trap it takes its name from.
First described in Japan in 1990, it was thought that 2,500 people in the UK suffer Takotsubo cardiomyopathy each year. However, new data suggest that this is a significant underestimation, with the real figure around 10,000 per year: which accounts for 7 per cent of all perceived heart attacks. This dramatic rise reflects a greater awareness of the condition among the medical community, but very little is known about its exact causes.
Takotsubo cardiomyopathy is a diagnosis made by exclusion: it presents with all the clinical features of a heart attack and is initially investigated and treated as such, but there are no blockages in the coronary arteries.
Curiously, Takotsubo cardiomyopathy has a predilection for women, but occasionally occurs in men as well. It has dramatic symptoms and is associated with intense emotions – usually of the stressful kind, but also of extreme joy or euphoria.
It also becomes more common at times of natural disasters such as flooding and earthquakes; and when an individual is suffering bereavement or has a severe illness such as cancer, adding to the evidence that stress is a precipitant of the condition. In some patients, however, no emotional trigger is found. Unlike other forms of cardiomyopathy, there is no convincing evidence of a genetic cause. Most patients recover their heart function, but up to 10-15 per cent relapse, and 3-5 per cent of patients die as a result of complications immediately after the onset of the illness, whether due to heart failure, heart rhythm problems or a stroke.
Dana Dawson, a professor of cardiovascular medicine at the University of Aberdeen, is an expert in Takotsubo cardiomyopathy. She acknowledges that there is no clear evidence of the exact mechanisms behind it. “Patients usually receive the same drugs used to treat other forms of heart failure, but it is not yet known what causes the heart to react to extreme stress in such a way [or] how to prevent future relapses.”
Dana Dawson has discovered, however, that it is associated with an “immune storm”, where the body produces increased quantities of inflammatory cells. These may remain elevated in up to 50 per cent of patients after they seem to have recovered, suggesting the condition is not as benign as originally thought. This new finding opens up the possibility of discovering the causes of Takotsubo cardiomyopathy and potential new treatments.
The interplay between our emotions and physical health is a developing field, and this condition represents a new branch of psychosomatic medicine. Fortunately, Rachel made a complete recovery and her heart has returned to normal. For now, she and her son have decided not to discuss politics. She joked, “This is proof that Brexit is bad for your health!”
Nishat Siddiqi is a cardiologist based in South Wales
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This article appears in the 23 Jan 2019 issue of the New Statesman, Who’s running Britain?