It is now known how mind and body are closely linked to each other and how the state of balance of one influence the well -being of the other.
We have always heard of crackinterpreting this expression more as a hyperbole rather than the reality of the facts. Over the past thirty years, scholars have discovered that this is not the right.
There Takotsubo syndrome It is also known as broken heart syndrome or stress cardiomyopathycan be caused by stressful situations and strong emotions.
Takotsubo syndrome symptoms
The main symptoms simulate those of a heart attack and include chest pain and short breath. The trigger can come following negative events or situations of anxiety and concern. For example, love disappointments, mourning, divorces, layoffs. Or external traumatic events, such as attacks, accidents or environmental catastrophes.
It was described for the first time in Japan in 1990. The syndrome affects a part of the heart, temporarily interrupting its normal capacity to pump blood.
The particular element is the form taken by the left ventricle of the heart. In fact, it changes conformation with respect to the physiological state: the final end rounds up, while the tip thinks, taking on the shape of the Japanese octopus trap from which the syndrome takes its name, Takotsubo.
Prognosis of syndrome
The complications it causes are curable and, if you intervene quickly and with the right therapies, the condition usually heals without long -lasting consequences.
At first it was thought that the broken heart syndrome was absolutely benignbut the data that emerged over the years have shown that this is not the right. However, only in rare cases it was ascertained as the cause of death.
There prognosis is usually goodwith a healing in 96% of cases. The ventricular function begins to recover its skills in a couple of days, with a return to normal within 3-4 weeks (ISS). It also seems to be no tendency to recidivism.
Incidence and risk factors for Takotsubo syndrome
Both age and sex are important criteria to consider: more than 90% of the people affected by TTS (Tako Tsubo Syndrome) in fact they are 58 to 75 years of age (the risk is higher after menopause).
About 2-5% of people with disturbances attributable to infarction are actually affected by this syndrome (ISS).
Risk factors are found situations of chronic or sustained alarm that precede catastrophic events and trauma. In Japan, for example, they observed that the incidence is particularly high after earthquakes.
Also the long e repeated lockdown due to Covid-19as well as the perception of danger and not control, have revealed an increase in the incidence of the broken heart syndrome. Comparing patients hospitalized from February to May 2020 with those of the corresponding period of 2019, a significant increase in the number of TTS diagnoses in 2020 (almost triple), especially during the first period of Lockdown, was observed.
The psychological examination all the patients examined report that they have lived a particularly stressful experience in the last year, without presenting the symptoms of a post-traumatic stress disorder (Barbieri et al., 2021).
The psychological predisposition
It seems increasingly evident, that even the mental condition of the person can affect the probability of manifesting the syndrome, following a strong stressful event.
Various studies have observed that patients with pre -existing psychopathology more often had the onset of syndrome following physical stress compared to patients without ailments.
The current evidence seems to suggest that patients with pre -existing psychiatric diseases are a greater risk of takotsubo syndrome. However, the diagnosis should be taken into consideration, when appropriate, even in the absence of an evident emotional discomfort (Nayeri et al., 2017).
Experiment with anxiety disorders and mood spectrum disorders therefore seems to represent a risk factor for TTS.
Personality and risk
Further research (Müller, Sperling & Kornhuber, 2017), about Personality assessmentsthey found that 46% of patients with Takotsubo syndrome observed showed a greater incidence of typical traits of the Cluster Cluster.
These are characterized by anxious or inhibited behavior conduct as anxiety, dependence traits and obsessive-compulsive traits.
The researchers also noticed that variables such as episodes of greater depression and stress management strategies were homogeneous and equally distributed within the sample. Therefore they concluded that these personality traits can be considered as important signals of vulnerability to the TTS.
These results could underline the importance of the clinical management of the TTS and its post-acute treatment through early psychotherapeutic interventions.
Causes of Takotsubo syndrome
Although the actual cause of this condition is not yet clear, it is believed that an important role can be played by the discharge of stress hormones issued following the activation of the sympathetic system of the autonomous nervous system, caused by a particularly intense physical or emotional event.
The latter therefore would trigger a high release of cortisol and catecholamines (such as adrenaline and norepinephrine). The excessive level of catecholamine would seem to lead to an increase in the concentration of calcium on the intracellular level. This could lead to a malfunction of the heart muscle.
In addition, catecholamines have a vasoconstrictor effect: even the correct functioning of the coronary and microcirculation would thus be compromised (ISS).
Possible triggering events
- The death of a loved one;
- The diagnosis of a very serious disease;
- Domestic violence;
- Heated discussions;
- The loss or winning of large sums of money;
- Surprise parties;
- Speak in public;
- Labor loss or financial problems;
- Separation or divorce;
- Physical stress such as asthma attacks, bone fractures or important surgery
Drugs at risk
It is also possible that some drugs, albeit rarely, cause the syndrome by triggering a discharge of stress hormones (this circumstance represents, however, a sort of confirmation of the causal role played by the catecholamines in the onset of broken heart syndrome):
- Epinephrine, used to treat allergic reactions or a serious asthma attack
- Duloxetine, prescribed to treat neuropathic problems (which affect the nerves of the peripheral or central nervous system) in people suffering from diabetes or even depression
- Venlafaxine, used in the treatment of depression, anxiety and panic attacks
- levotiroxine, a drug prescribed to people whose thyroid gland is not fully functional
- illegal stimulants, or not prescribed by a doctor, such as cocaine or metamfetamine
Taketotsubo syndrome treatment
Until the diagnosis is certain, the treatment of Takotsubo syndrome is similar to that provided in the event of a heart attack.
Most affected people are hospitalized until healing.
Once established that Tako Tsubo’s syndrome is the cause of the disorders warned by the person, the doctor prescribes the therapy to be taken in the hospital. That is, drugs that help to reduce the workload of the heart and prevent further episodes.
Many people heal completely within a month or a little more. They may need to undergo a control echocardiogram every 4-6 months Since they warned syndrome disorders, to verify that there have been no consequences on the heart and continue to take the therapy prescribed by the doctor: in most cases the cure will have to continue for about 3 months.
In addition to these types of interventions, doctors strongly advise you to contact an expert in stress relaxation and management techniques, to learn to face and manage any intense and stressful emotional situations in functionally.
Prevention
Recognizing and managing anxiety can help Prevent Takotsubo syndrome. It is important that the person learn to control their reactions and emotions in the face of situations of physical and emotional stress.
The practice of relaxation techniques, correct and continuous physical activity and the intake of anxiolytic drugs (ISS) are therefore recommended.
Knowing how to manage stress can in fact be fundamental to prevent Takotsubo syndrome. Some of the most important forms of prevention are:
- Relaxation techniques: fall into the category of psychophysiological interventions. They aim to reach a condition of relaxation, characterized by the reduction of muscle tension, heart rate, blood pressure, respiratory frequency and modification of brain activity towards a state of mental calm.
- Meditation and Mindfulness: it is a state of consciousness in which we are vigilant and present witnesses of our thoughts, our emotions and perceptions, moment by moment.
- Yoga: body discipline, which, similarly to mindfulness, promotes and trainee for acceptance of the present moment by working on the body.
- Sports activity: able to produce an increase in the concentration of endorphins, chemicals present in the human brain that work as natural calming and produce sensations of pleasure.
- Psychotherapy: considering the data exposed above, it is clear that the preventive usefulness of a psychotherapy intervention on psychological or problems relating to anxiety and spectrum of mood may be of fundamental importance. Furthermore, indulge in the opportunity to intervene on personality structures, see Cluster C specifically, but not only, and learn to manage emotion in a more functional way, as well as it allows you to obtain benefits directly aimed at the construction of defenses and resources to contrast the possible onset of the TTS, allows you to achieve psychological well -being and improve the quality of life, thus playing a basic role as a general protection factor.
Bibliography
Barbieri L., Galli F., Conconi B., Gregorini T., Lucreziotti S., Mafrici A., Pravettoni G., Sommaruga M., Carugo S. (2021) Takotsubo Syndrome in Covid-19 was: is psychological distress the key?, Journal of Psychosomatic Research, volume 140
ISSalute – Tako Tsubo syndrome
Müller HH, Sperling W. & Kornhuber J. (2017). Cluster C Personality Accentuation in Patients With Takotsubo Cardiomyopathy Personality Traits Mark Vulnerability, Psychiatry Danubine; Vol. 29, No. 1, pp 93
Nayeri A., Rafla-Yuan E., Farber-Eger E. (2017): Pre-Existing Psychiatric Illness is associated with Incased Risk of Recurrent Takotsubo Cardiomyopathy. Psychosomatics; 58: 527–532
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