An international team of researchers has discovered a new link between “broken-heart syndrome” and the second leading cause of death in the world: cancer. Their study, which was recently published in the Journal of the American Heart Association, found that one in six people with the syndrome had cancer and were less likely to still be alive five years after its development.
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Officially called takotsubo syndrome (TTS), broken heart syndrome is a temporary condition that arises when the left ventricle (the main part of the heart that pumps blood around the body) suddenly enlarges, weakens and fails to pump blood properly. The rest of the heart either maintains normal function or contracts more forcefully. Other names for broken heart syndrome include stress cardiomyopathy, apical ballooning syndrome, and takotsubo cardiomyopathy.
The condition is often triggered by stressful emotional situations such as the death of a loved one or physical stressors such as severe illness or surgery.
Other potential triggers include:
- Receiving a worrying medical diagnosis
- Significant financial loss
- Loss of employment
- Public performances
The precise cause of broken heart syndrome is unclear, but scientists think that the way the heart responds to a sudden surge of stress hormones such as adrenalin may cause a temporary loss in function. A temporary constriction of the arteries that supply the heart is also suspected to play a role.
In rare cases, certain drugs may trigger the syndrome by inducing a surge of stress hormones.
The difference between broken heart syndrome and heart attack
A heart attack generally arises when a coronary artery becomes completely or nearly completely blocked due to the formation of a blood clot in the wall of the artery.
A person experiencing broken heart syndrome may feel like they are having a heart attack, with symptoms commonly including sudden chest pain, shortness of breath and a very fast or irregular heartbeat.
Although the symptoms can mimic those of a heart attack, the heart muscle remains undamaged and there is no blockage of the coronary arteries, although blood flow through the arteries may be restricted.
The link between broken heart syndrome and cancer
Although the condition has long been connected to severe physical or emotional trauma, this new international study conducted across 26 centers, suggest that such events may not be the only trigger and provides the strongest evidence to date of an association between broken heart syndrome and cancer.
In a statement from the American Heart Association, lead author Christian Templin from the University Hospital Zurich in Switzerland suggests that people who experience TTS symptoms be vigilant: “Patients with broken heart syndrome might benefit if screened for cancer to improve their overall survival.”
Aside from advising the general public to inform themselves about the connection between TTS and cancer, Templin recommends doctors also keep aware:
Our study also should raise awareness among oncologists and hematologists that broken heart syndrome should be considered in patients undergoing cancer diagnosis or treatment who experience chest pain, shortness of breath, or abnormalities on their electrocardiogram.”
Screening should be increased for patients with broken heart syndrome
For the study, Templin and team recruited patients with TTS from the International Takotsubo Registry and divided the cohort into those with and without malignancy to explore any differences in clinical characteristics and to assess short‐ and long‐term mortality.
Of the 1,604 TTS patients (aged an average of 69.5 years) included in the study, 276 or one in six had cancer, with the most common malignancy being breast cancer, followed by cancer of the gastrointestinal tract, respiratory tract, internal sex organs, skin and other areas of the body.
Compared with patients who did not have cancer, the researchers found that those who did have cancer were significantly less likely to have experienced an emotional trigger of the syndrome, at 18% versus 30.3% and significantly more likely to have experienced a physical trigger of the syndrome, at 47.9% versus 34.2%.
They were equally as likely to survive for 30 days following development of the syndrome, although more likely to require intensive cardio or respiratory support during their hospital stay. They were also more likely to die within five years of the syndrome first developing.
The team concludes:
A substantial number of TTS patients show an association with malignancy. History of malignancy might increase the risk for TTS, and therefore, appropriate screening for malignancy should be considered in these patients.”
Unfortunately, the study was not large enough for the team to assess whether the worse prognosis among TTS patients with cancer may be dependent on the type or stage of cancer or which treatments patients have received. This will be investigated in a follow-up study by the researchers.
"The mechanism by which malignancy and cancer treatment may promote the development of broken heart syndrome should be explored, and our findings provide an additional reason to investigate the potential cardiotoxic effects of chemotherapy," concludes Templin.
Can broken heart syndrome be prevented?
In a small number of cases, a repeat episode of TTS arises following an initial episode and there is no known therapy that can prevent this from happening.
Many physicians recommend ongoing treatment with medications such as beta-blockers to prevent the potentially damaging impact that stress hormones can have on the heart. Approaches to managing life stressors could also help to prevent the syndrome arising, although there is not yet any reliable evidence to prove this.
Cammann, V. L., et al. (2019). Clinical Features and Outcomes of Patients With Malignancy and Takotsubo Syndrome: Observations From the International Takotsubo Registry. JAHA. https://www.ahajournals.org/doi/10.1161/JAHA.118.010881