Following traumatic experiences, such as a divorce or the loss of a loved one, individuals may encounter symptoms like chest pain and shortness of breath.

This phenomenon, clinically termed takotsubo cardiomyopathy, is believed to arise from emotional or physical stress that triggers a surge of hormones, including adrenaline, which hampers the heart’s ability to contract effectively. While most individuals recover swiftly, a minority may face heart failure.

Wounded heart syndrome predominantly affects women; however, men have a mortality rate that is more than double that of women. A study published recently in the Journal of the American Heart Association highlights this disparity.

The research examined data from around 200,000 adults in the U.S. who were hospitalized for this condition between 2016 and 2020. It found that nearly 11% of men in this group died, compared to about 5% of women. This was supported by previous studies indicating a higher mortality rate among men.

“It’s consistently noted that men generally do not experience takotsubo syndrome as frequently, but when they do, the outcomes tend to be worse,” explained Dr. Harmony Reynolds, director of NYU Langone Health’s Center for Women’s Cardiovascular Research, who was not part of the study.

The differences between men and women could be tied to the triggers of their conditions, according to the cardiologist. In men, the syndrome is often instigated by physical stressors like surgery or stroke, whereas in women, the triggers tend to be emotional, such as job loss or the death of a loved one.

“Individuals facing emotional stressors tend to fare better,” noted Dr. Iran Wittstein, a cardiologist at Johns Hopkins Medicine who was not involved in the study.

“Men appear to have a higher risk of severe outcomes or mortality, suggesting that a more dangerous trigger is necessary for syndrome onset.”

Dr. Mohammad Movahed, the principal investigator of the study, added that men may also struggle more with recovery from takotsubo cardiomyopathy. Research indicates lower social support for men to help them cope with stress.

“If the stressor is transient and then removed, there could still be damage to the heart or diminished recovery chances,” Movahed, a cardiologist at the University of Arizona Sarver Heart Center, explained.

However, scientists continue to explore the underlying mechanisms of the syndrome and why fatalities occur in rare instances.

“Researchers are still pursuing to uncover the definitive causes of this condition,” Wittstein remarked.

Is stress the only trigger?

To diagnose takotsubo cardiomyopathy, physicians look for certain hallmark signs. Typically, in affected patients, parts of the heart muscle balloon out, but there are usually no blocked arteries, which would indicate a heart attack. Most patients can also identify stressors that led to their episodes.

“During these moments, we feel the weight on our hearts,” stated Dr. Matthew Tomey, a cardiologist at Mount Sinai St. Luke’s Hospital in New York City. “It’s as if heartache manifests physically.”

However, Wittstein cautioned that stress alone may not suffice to trigger takotsubo syndrome.

“Some individuals might have minor work-related frustrations, engage in a slightly intense jog, or experience irritation at a red light,” he described.

Reynolds shared that one of her patients had four instances of the syndrome, each stemming from a mild stomach bug that caused vomiting.

“She is quite averse to vomiting, which likely contributed to her incidents,” she noted.

Wittstein now posits that certain individuals may harbor an inherent sensitivity to takotsubo syndrome. His findings suggest that stress hormones narrow small blood vessels around the heart, limiting blood flow and making some individuals, especially those with high blood pressure or cholesterol, more vulnerable.

Research indicates that postmenopausal women are at an elevated risk of developing this syndrome, potentially due to decreased estrogen levels, which facilitate the dilation of small blood vessels around the heart.

However, Reynolds emphasized that further research is needed to fully understand these mechanisms.

“There’s a suggestion that sex hormones may play a role, but establishing that link is still an ongoing challenge,” she said.

It’s complex to manage and prevent

The intricate nature of takotsubo cardiomyopathy can complicate its prevention and treatment.

Doctors often seek ways to alleviate stress, sometimes prescribing medications intended for other heart conditions, such as beta blockers, or recommending meditation and mental health support.

“To date, we have not identified any preventive drugs that effectively reduce complications, mortality rates, or specific therapies,” Movahed stated.

The new study found that mortality rates associated with takotsubo syndrome remained relatively stable from 2016 to 2020.

However, Wittstein noted that the study relies on diagnostic codes assigned to hospitalized patients, which might overlook broader circumstances influencing a patient’s death, particularly regarding strokes or other neurological issues.

“I suspect many individuals recover from takotsubo syndrome but subsequently succumb to other complications,” he remarked.

The cardiologist advises patients to seek immediate medical attention if they experience chest pain or shortness of breath, rather than attributing it solely to stress.

“Only through a comprehensive evaluation at the hospital can we differentiate between this condition and a traditional heart attack,” Reynolds cautioned. “Thus, it’s critical not to ignore chest pain.”