Broken Heart Syndrome Linked to a Stressed Brain

Broken Heart
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According to a study, higher activity in the Amygdala can increase the risk of developing broken heart syndrome.

If there’s something people all over the world can relate to, it’s the feeling of a broken heart. We’ve all been there. Contemplating whether the heartbreak will eventually cause our death; probably even wishing for death rather than dealing with a broken heart. And while most people have called us dramatic, it seems science is on our side. According to science, one can die of a broken heart. It is called the broken heart syndrome, or Takotsubo syndrome (TTS).

People with broken heart syndrome usually present with chest pain and shortness of breath. Although the symptoms resemble a heart attack, there are no blocked arteries in TTS. Instead, an intense, emotionally stressful event results in the weakening of the cardiac muscles. This leads to the left ventricle enlarging from the bottom and its neck constricting. Thus, coming to resemble a Japanese octopus trap which translates to ‘takotsubo’ in Japanese. Hence, the name.

It is unclear as to how emotional or physical stressors may bring about such changes in the heart. However, a study published in the European Heart Journal has now found a link between TTS and a stressed brain.

Can Stress Break Your Heart?

The Amygdala is the part of the brain that controls emotional responses, memory, and learning. It also regulates the heart in response to emotions such as fear. Therefore, Dr Ahmed Tawakol, hypothesized that increased activity in the amygdala, in response to stressors, can lead to the development of TTS.

Dr. Tawakol and his colleagues analyzed brain scans of patients with TTS, and a control group. All had undergone scans at Massachusetts General Hospital between 2005 and 2019. Mostly to check for cancers. This is the first time a study has looked at brain scans that assessed brain activity using F-fluorodeoxyglucose positron emission tomography/computed tomography (PET-CT). Out of the 104 patients, 41 had gone on to develop TTS six months to five years after the scan.

Findings revealed that those who went on to develop TTS had higher stress-related activity in the amygdala compared to those who did not. Furthermore, the higher the activity in the amygdala, greater the risk of developing TTS in the patients.

The study suggests that the increased stress-associated neurobiological activity in the amygdala, which is present years before TTS occurs, may play an important role in its development and may predict the timing of the syndrome. It may prime an individual for a heightened acute stress response that culminates in TTS.

Dr Ahmed Tawakol, study leader, co-director of the Cardiovascular Imaging Research Center at Massachusetts General Hospital and Harvard Medical School

It is hypothesized that physical or emotional stress may lead to the activation of stress-related areas in the brain. The brain activity in turn triggers the release of stress hormones which activate the sympathetic nervous system. Along with the release of inflammatory cells. Thus, all these steps result in the development of broken heart syndrome.

Authors of the study suggest that future interventions should target this stress-related brain activity to reduce the risk of developing TTS.


Radfar A, Abohashem S, Osborne MT, et al. Stress-associated neurobiological activity associates with the risk for and timing of subsequent Takotsubo syndrome. Eur. Heart J. 2021;(ehab029). doi: 10.1093/eurheartj/ehab029


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