In the first ever
study to compare takotsubo patients with heart attack patients and the general
population over more than 5 years, results showed that heart treatments given
after takotsubo do not protect patients. The study was funded by the British Heart
Foundation.
The team, led by
Professor Dana Dawson, from the University of Aberdeen Cardiology and
Cardiovascular Research Unit, analysed data from 3,720 people over a decade and
found that takotsubo patients were prescribed the same medication as heart
attack patients. They say while this approach worked for the heart attack
patients, these medications did not improve the survival rate of takotsubo
patients.
Patients who
suffered from takotsubo were more likely to die than the general population and
just as vulnerable to dying as patients who had suffered a ‘true’ heart
attack.
Published
in JACC:Advances this week, the study used data from Public Health Scotland
– the only database in the world that can provide accurate data on patient
treatment and follow-up, including medication prescribed across their
lifetime.
Currently, there
is no expert consensus how to treat the condition. Instead, medicines used to
treat other heart conditions, like heart failure and heart attacks are used.
However, takotsubo is not the same as these heart conditions.
Professor Dawson
explains: “Takotsubo cardiomyopathy can be triggered by extreme emotional
distress, leading to its nickname of broken-heart syndrome.
“It happens as a
reaction to upsetting events such as the death of a family member, the ending
of a relationship or illness, when distress signals travel from the brain to
the heart. But 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. It can develop at any
age, and typically affects more women than men.
“Symptoms can
appear like a heart attack including shortness of breath and chest pain.
“But takotsubo
cardiomyopathy is a different condition entirely and unlike a heart attack,
patients don’t suffer from a blockage of the arteries that supply the heart
with blood.”
Upon identifying
the treatment received by takotsubo patients, Professor Dawson said: “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.
“These patients
have increased mortality compared to the general population, an increased
vulnerability to developing heart conditions and as much chance of dying from
this as people who have suffered heart attacks.
“It is vital that
we identify precise ways to treat this unique group of people, and that is what
we plan to do as we continue our research. This study has identified one drug
as a potential breakthrough with promising therapeutic benefit, however, further
research is needed to establish if this is the key to treating this devastating
illness”
Dr Sonya
Babu-Narayan, Associate Medical Director at the British Heart Foundation, said:
“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.
Patients surviving takotsubo syndrome were treated much the same way as those
surviving a heart attack - but unlike for heart attack survivors, being
prescribed usual heart medications was of uncertain benefit. More research into
takotsubo could better reveal its causes and which treatments could save and
improve lives.”
Case
Study: Michelle Canning
Michelle Canning
was diagnosed with a takotsubo cardiomyopathy in January 2021, following the
death of her father the previous year.
Michelle, who was
49 years old at the time, experienced pains in her chest and arm on her way to
a routine doctor's appointment one morning. Initially Michelle wrote it off as
indigestion but told her GP, upon arrival, who then conducted an ECG test.
The mum of three,
who was then vegan, doesn't smoke, doesn't regularly drink alcohol and at the
time exercised multiple times a week, was admitted to hospital with a suspected
heart attack.
However, an
angiogram revealed that Michelle's arteries were clear and there was no
coronary damage to her heart. Instead, she was diagnosed with takotsubo
cardiomyopathy, a condition also known as 'broken heart syndrome' that can be
triggered by stressful events.
Michelle was told
her condition was most likely triggered by the sudden death of her dad Tommy in
three months earlier.
A former
journalist who went onto a career in crisis communications, she describes
herself as “emotionally resilient.”
"I'm a very
easy going being, I don't get very stressed and I'm not very dramatic - I take
things in my stride. So this was a shock to know that I had developed this
condition as a result of stress.
"None of it
made sense but the reality is that stress was manifesting itself physically
when I did not feel stressed and that's frightening.”
Michelle has
since become an advocate for women’s health highlighting the issue as one of
the health inequalities that exist for women and has addressed an all-party
group on women’s health in the North of Ireland about her condition and the
need for a women’s health strategy.
“I had amazing
care from my GP and hospital staff and I cannot thank them enough. But I left
hospital not really knowing what had happened to me or if it would happen
again. So the last two years have been a real journey of exploration to find
out why it happened to me.
“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. And I don’t think it is any surprise that this is a condition that mostly
affects women. It is difficult to try and manage a condition when there isn’t
enough known about it and yet the triggers are many.
"It's a bit
of a lonely journey because there aren't many people like you. I left the
hospital knowing nothing about what had happened to me or what would happen
next. I'm lucky I had the agency to go find organisations for further
information and come across the efforts being made to find out
more.
"The British
Heart Foundation was incredible. In the weeks following my takotsubo I was able
to ring them and chat to nurses if I had pains or concerns - I just didn't know
whether or not it was happening again, how far I could walk, or whether I could
go back to work.
"There needs
to be more awareness in current healthcare settings and in professionals to
tell someone who's had a Takotsubo, here is what has happened, this is the plan
for recovery and here are the people you can contact. And it must be tailored
to the condition."
"Fortunately,
the condition is reversible and I am now recovered. However, there is a chance
of a recurrence. All I can do is try to manage stress, but then I am stressed
by the fact I've had this rare condition and it could happen again. There is nothing
that I can do to prevent that.
"Everything
I do from here on in will be shaped by my experience in a way I couldn't have
possibly known about, but I'm blessed and very lucky that there appears to be
no damage and that I am alive and well. Others have not been as
fortunate.
"I have the
opportunity to celebrate and enjoy life every day. The further away I am from
the actual episode, then the more life has taken on a more normal perspective
for me and the fear subsides, but I do want to share my experience in the hope
it helps others get the right treatment and care.”