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Interdisciplinary VCU research team provides clinical and diagnostic guidance for broken-heart syndrome

Medical image of a brain and a heart with boxes reading "Emotional Stress -Negative (and positive emotions - Natural disasters" "Physical stress - trauma/surgery - medications -intoxication -drug withdrawal" "Risk Factors -female sex -post-menopause -schizophrenia -anxiety/depression -asthma/chronic obstructive pulmonary disease -diabetes - chronic medications - substance abuse disorders" "endothelial dysfunction" "chronic microvascular dysfunction" "impaired coronary flow reserve" "stress cardiomyopathy" "direct cardio-inhibitory effects" and "acute microvascular dysfunction
Broken heart syndrome usually results from severe emotional or physical stress such as the death of a loved one. (Image courtesy of the Journal of the American College of Cardiology)

A team of cardiology and psychiatry specialists from Virginia Commonwealth University has authored a new comprehensive clinical review article in the Journal of the American College of Cardiology that summarizes the latest evidence-based diagnostic criteria and treatment strategies for Takotsubo cardiomyopathy, also known as broken-heart syndrome.

“Takotsubo cardiomyopathy is a recently recognized condition that is difficult to diagnose and treat,” said corresponding author Antonio Abbate, M.D., Ph.D. Abbate is a cardiology professor at VCU School of Medicine. A provider at VCU Health's Pauley Heart Center, he serves as associate director of the C. Kenneth and Dianne Wright Center for Clinical and Translational Research and as medical director of the Clinical Research Services unit.

In the state-of-the-art review, the interdisciplinary research team summarized all that is known about the condition, reviewing the proposed risk factors and triggers for the syndrome and discussing practical approaches to diagnosis and treatment. They also highlighted potential challenges and unresolved questions.

The disease, described as a weakening of the heart’s left ventricle, usually results from severe emotional or physical stress such as the death of a loved one. More than 90 percent of reported cases are in postmenopausal women — ages 58 to 75 — who experienced severe, unexpected emotional stress one to five days before the onset of symptoms. The condition is reversible, but often misdiagnosed, and can lead to stroke and death. Asthma, depression and substance abuse — including cannabis use — are also risk factors. “In the article, we discussed that some part of the brain may be overactive in response to an emotional or physical stressor,” Abbate said.

Antonio Abbate, M.D., Ph.D.
Antonio Abbate, M.D., Ph.D.

The review builds on existing VCU research conducted by co-author and Wright Center Director F. Gerard Moeller, M.D., including reports on complex cases of Takotsubo cardiomyopathy at VCU Medical Center and pre-clinical studies that highlight the interplay between the brain and heart. The researchers plan to use the Wright Center’s research-dedicated MRI scanner to explore further the brain-heart connection in patients who present with the condition, and to explore the link to cannabis.

“A state-of-the-art review is the most prestigious type of literature review,” Abbate said, adding that the Journal of the American College of Cardiology is ranked among the top three journals in the field of cardiovascular medicine. The reviews are referenced by clinicians as guidance for disease management. “Our review will be available to providers worldwide, and may help guide diagnosis and treatment.”