Internet CBT may help to heal a broken heart

Text: Felicia Lindberg, first published in the magazine Medicinsk Vetenskap nr 3, 2023. 

Per Tornvall has done research on broken heart syndrome for roughly 20 years and can remember clearly what first awakened his interest. A woman in her 50s came into the myocardial infarction unit at Karolinska University Hospital, where he was working as a cardiologist at the time. She had classic symptoms of a myocardial infarction, but one could not detect any narrowing of the heart's coronary arteries, which is normally indicative of a myocardial infarction. 

"She was a middle manager at a large company where constant organisational changes were causing her a great deal of stress, she felt pressure both from upper and lower management. I didn't know at the time what the cause was but suspect today that she was suffering from broken heart syndrome. Since then, I have devoted my research to trying to find risk genes and examining how the condition can be diagnosed and treated," says Per Tornvall, Professor at the Department of Clinical Science and Education, Södersjukhuset, at Karolinska Institutet and Senior Consultant at the cardiology clinic at Södersjukhuset. 

Broken heart syndrome was first discovered in Japan in the 1990s and is also referred to as takotsubo after the Japanese word for octopus trap, which describes the appearance of the heart ventricle in patients who suffer from this. One of the ventricles, typically the left one, swells up and becomes like a limp bag, which makes it harder for the heart to pump. The consequence is typical symptoms of a myocardial infarction, with chest pains, breathlessness and sometimes fainting. Blood counts and ECG (electrocardiography) also indicate myocardial infarction, but since the heart's coronary arteries are healthy it is a separate condition that is rather similar to heart failure. 

Broken heart syndrome has shown to be the cause of a few percent of all suspected myocardial infarctions, with a clear over-representation among women. 

"In total, at least a thousand people per year in Sweden are affected by this and the typical patient is a woman in her upper middle age who has recently suffered severe stress or grief. I would like to call it a brain-heart disease," says Per Tornvall. 

Research shows that there is a strong link to mental or physical stress. Studies have also shown changes in the part of the brain that controls the so-called autonomous nervous system, which controls our inner organs. 

"During my years as a cardiologist, I have encountered many patients who tell me about dramatic events such as the sudden loss of a family member, traffic accidents and houses burning down with the pets still inside. You can often see that there is both prolonged stress and acute stress which may have been the last straw. One has also noted an increase in heart problems similar to takotsubo in connection with major disasters such as earthquakes and terrorist attacks. 

Why this occurs to women to a larger extent has not been pinpointed, but some studies indicate that oestrogen plays a role. When oestrogen levels drop in connection with menopause, the number of stress receptors in the heart increases. In younger women and men, broken heart syndrome is also equally common, but after menopause it is around five times more common in women.