‘Heart-Brain Connection’ Linked To Broken Heart Syndrome

A new study shows that a chronically stressed amygdala can prime the heart to overreact to acute stress events.

Takotsubo cardiomyopathy or Takotsubo syndrome (TTS), also known as broken heart syndrome, is a rare, reversible condition that disproportionately affects women with only 10% of cases occurring in men. TTS usually appears after a stressful event, such as the death of a loved one, divorce, or the loss of a job.

This syndrome is so named because it causes the heart’s left ventricle to weaken so that the organ assumes a shape reminiscent of the Tako-Tsubo pot used in Japan to catch octopuses.

During stressful events, a massive surge of catecholamines such as adrenaline and norepinephrine are being released by nerves cells that stimulate cardiac muscle cells. Excessive amounts of these neuromodulators can have a toxic effect and can lead to ‘stunning’ — decreased cardiac muscular function.

This adrenaline surge results in vasoconstriction — narrowing of blood vessels — of the arteries leading to higher blood pressure, therefore, placing more stress on the heart.

Subsequently, this may lead to spasms of the coronary arteries which impairs the arteries from delivering adequate blood flow and oxygen. Together, these events can lead to a weakening of the heart’s left ventricle such that it becomes temporarily misshapen.

Earlier research already showed that TTS patients have elevated activity in their amygdala. The amygdala is responsible for initiating a fast, automatic response, a.k.a. the fight-and-flight response. However, whether this activity began many years before or happens as a result of the syndrome has never been clear.

Until now.

A recent study published in the Europea Heart Journal analyzed full-body PET/CT scans from 104 patients, most of whom had cancer. There were 63 individually matched controls and 41 had developed TTS since first being scanned.

The research team calculated ratios of the activity in each person’s amygdala to that of the temporal lobe and prefrontal cortex, two brain regions that act as a braking system to the stress response.

Higher amygdala activity was associated with an increased risk for TTS. Furthermore, patients with higher ratios had developed the condition roughly two years earlier following the imaging than those with lower ratios among the TTS patients.

Shady Abohashem, MD, a cardiovascular research scholar at Harvard Medical School-Massachusetts General Hospital, and co-author of this paper commented:

“We can now show that this syndrome happens as a result of chronic stress over years that makes you vulnerable to developing the syndrome more easily and sooner than [less stressed] people,”

“Although a link between the brain and heart has long been proposed as a critical factor in the development of takotsubo syndrome, the underlying mechanisms have not been well described,”

Ahmed Tawakol, MD, director of nuclear cardiology and co-director of the cardiovascular imaging research center at Massachusetts General Hospital, told Healio.

“The current study points to a proximal, and potentially key, component of that mechanism. Specifically, heightened activity in stress-related centers of the brain was found to exist prior to the development of the syndrome, and thus may act as a risk factor for the disease by increasing the likelihood that exposure to a substantial stressor would result in takotsubo syndrome.”

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