SCOTS researchers are trying to find out why grief, shock or even a surprise marriage proposal can trigger a potentially fatal condition that mimics a heart attack.
Hormones released squeeze the blood vessels around the heart causing a temporary blockage that leads to patients experiencing pressure and pain in the upper chest and breathlessness.
Experts say Takotsubo cardiomyopathy, is a neglected area of cardiology and the condition has only been recognised in the past few years.
The exact cause is not clearly understood but an acute episode can be triggered by severe emotional distress, such as the death of a loved one.
As a result, when it was first discovered, it was also referred to as “broken heart syndrome”.
However, researchers now believe it can be caused by a number of different factors, including intense physical trauma, but also lesser physical or emotional upsets or no incident at all.
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It affects women and men of all ages, although some studies suggest it is more likely to affect women over the age of 60, and although a great deal of recovery occurs, there can be long-lasting damage to the heart muscle
The first study of its kind, led by Aberdeen University and funded by British Heart Foundation Scotland, hopes to shed new light on what actually happens to people who have suffered Takotsubo cardiomyopathy.
Initial evidence suggests that overall the longer-term outcome can be as significant as someone who has suffered a heart attack.
Jacqui Newton, 64, believes the stress of giving a presentation led to her suffering what paramedics initially thought was a heart attack.
She was invited to a medical conference in London in June 2019 to share her experience of having sarcoidosis, a rare disease which is caused by an over-activity of the immune system.
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It was the first time Jacqui had spoken publicly about her illness and she believes the heightened emotions may have triggered the episode.
"While I was going through it I could feel a huge weight on my chest," said Mrs Newton.
"I had hurriedly eaten a sandwich at lunchtime and I put it down to that. I think it was the excitement too and I know that it can be brought on if someone gets a surprise marriage proposal.
"It is the stress hormones, whether it's good or bad, attacking the heart. I have a particular kind of neuro-scarcoidosis and when I read more about it I realised I ticked most of the boxes.
"One is being over 60, another is excitement or terrible news and the other is having a neurological condition.
"I was aware that heart attacks are different in women than they are in men.
"It was pressure really high in the chest, almost in the bottom of the collar bone.
"While I talked I started to take really deep breaths and was letting it out slowly and I felt that eased the pressure a bit."
The mother-of-three who lives in Perth said her symptoms intensified after she finished her presentation with the pain spreading to her back.
She spoke to her consultant, who was attending the event and asked him if she could be experiencing a heart attack.
"He said that it was possible but didn't say 'off you go to A&E so I went back to my son's, who lives in London and told him what had happened."
However by midnight the pain had increased and she was afraid to go to sleep.
"I didn't believe it was a heart attack but I called 999. They did an ECG there and then and said 'you are having a heart attack.' They said I had suffered a blood clot and I remember thinking that's not good as my mother had died of that."
She was taken straight to the hospital's cath lab where an angiogram showed she hadn't suffered a heart attack but an acute episode of Takotsubo cardiomyopathy.
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"You could see the bottom side of the heart bulging out and the blood pooling that wasn't being pumped out."
Ms Newton recovered after treatment with blood pressure medication and statins but said she has been left with lasting symptoms including shortness of breath and says she does worry it could happen again.
The study will examine data from all recorded cases of the condition in Scotland since 2010 and once complete, it is hoped the findings will help inform future research trials and clinical practice.
Professor Dana Dawson, Consultant Cardiologist at Aberdeen Royal Infirmary, who is leading the research, said: “Takotsubo cardiomyopathy is a sudden and potentially catastrophic heart problem sometimes caused by stress.
"But the condition has only been recognised in recent years and so our knowledge remains limited.
"As such, it is vital that we learn more about this neglected area of cardiology and its longer-term impact on patients.”
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