Researchers have found that emotional stress may not be the only trigger for broken heart syndrome, a heart condition that can be triggered by mental or physical stress.
A study published Wednesday in the Journal of the American Heart Association found that one in six people with broken heart syndrome also had cancer, and those with cancer were less likely to report an emotional trigger for their heart symptoms.
Though its name may sound like a Hollywood phenomenon, broken heart syndrome—also known as takotsubo syndrome—occurs when the main chamber of a patient’s heart temporarily enlarges, causing it to pump abnormally.
The condition often presents with heart attack-like symptoms, including chest pain and shortness of breath.
Though many cases are triggered by emotionally stressful events, researchers say this study draws the strong association between the syndrome and cancer.
“Patients with broken heart syndrome might benefit if screened for cancer to improve their overall survival,” Christian Templin, senior author of the study, said in a press release.
“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.”
Compared to those without cancer, broken heart syndrome patients with cancer were almost twice as likely to have experienced a physical trigger versus an emotional trigger before experiencing heart symptoms.
Of those with cancer, 90 per cent of patients studied were women.
According to the American Heart Association, more women than men experience broken heart syndrome overall.
Researchers note that the study is too small to analyze whether the link between the conditions is related to a specific type of cancer, or the cancer treatments received.
But study authors note the findings provide context to study the “potential cardiotoxic effects of chemotherapy.”
Broken heart syndrome
The condition was first identified in Japan in 1990, where physicians noticed people with heart attack symptoms but, upon further testing, none of the signature blood clots that cause heart attacks.
Instead, the condition is triggered when a severe stressor — such as financial loss, a fierce argument or a natural disaster — causes physical damage to the heart. Cardiomyopathy ensues, because the heart’s main pumping chamber temporarily enlarges and doesn’t pump well. The syndrome feels like a heart attack, with chest pain and shortness of breath, but there is no heart muscle damage and no blockage in the coronary arteries feeding the heart.
Increased levels of stress hormones are thought to be one of the main drivers of broken heart syndrome. And some experts believe that cancer may also play a role.
“The interplay between the two is unclear, but many cancer treatments can also have an effect on the heart,” said Dr. Laxmi Mehta, director of preventative cardiology and women’s cardiovascular health at Ohio State University.
Mehta, who was not involved with the new research, added that it’s important to look at the patient as a whole. “Many of the risk factors between cancer and cardiovascular disease overlap, such as smoking, family history, poor diet and lack of exercise,” she said.
Prior research has shown that treatment with certain cancer drugs has been associated with the syndrome, particularly 5-fluorouracil and rituximab, but the exact reason why this occurs in some people has been elusive.
Because of this, “if someone has underlying heart disease and a history of cancer, they need to see their cardiologist and discuss if the drugs they’re taking are OK to continue taking,” Mehta said.
Dr. Francesco Santoro, a cardiologist at the University of Foggia in Italy and a leading expert in broken heart syndrome, said that he also wasn’t quite sure why those with cancer fared worse after suffering broken heart syndrome than those without cancer. But he noted that “more research needs to be done to clarify the reasons for this, and if a combination of standard heart failure drugs may provide a benefit.”
“I don’t have any tricks, but if a patient with heart break syndrome doesn’t have a clear stressor, then maybe doctors should look for cancer,” he said.