Takotsubo syndrome, also known as stress cardiomyopathy or broken heart syndrome, is a sudden and temporary weakening of the heart muscles that affects the left ventricle, the chamber responsible for pumping blood to the rest of the body.

This condition is triggered by intense emotional or physical stress, such as a major life event, a severe illness, surgery, or a car accident.

For many years, Takotsubo syndrome was thought to be harmless and self-limiting, but recent studies have shown that it can have serious consequences, including heart failure, recurrent episodes, and even death.

Furthermore, there is growing evidence that Takotsubo syndrome may be connected to cancer, both as a risk factor and as a consequence.

What Is Cancer?

Cancer is a group of diseases characterized by the uncontrolled growth and spread of abnormal cells in the body. There are many types of cancer, including breast cancer, lung cancer, prostate cancer, colon cancer, and leukemia, among others.

Cancer can develop in any tissue or organ, and it can cause a variety of symptoms, depending on the location and stage of the disease.

Cancer is caused by a combination of genetic and environmental factors, such as smoking, radiation exposure, viral infections, and unhealthy diet and lifestyle.

Cancer can be treated with surgery, radiation therapy, chemotherapy, immunotherapy, or a combination of these modalities, depending on the type and stage of the disease.

What Is Takotsubo Syndrome?

Takotsubo syndrome was first described in Japan in the 1990s, based on the observation of patients who presented with acute chest pain, shortness of breath, and abnormalities on electrocardiograms (ECGs) that mimicked a heart attack.

However, upon further investigation, these patients were found to have no significant blockages in their coronary arteries, which are the blood vessels that supply oxygen and nutrients to the heart muscle.

Instead, Takotsubo syndrome was found to be caused by a sudden surge of stress hormones, such as adrenaline, which can overwhelm the heart muscles and cause them to contract abnormally.

Takotsubo syndrome got its name from the shape of the left ventricle on echocardiograms or angiograms, which resembles a Japanese fishing pot called takotsubo.

What Are the Symptoms of Takotsubo Syndrome?

The symptoms of Takotsubo syndrome can vary, but they often include the following:.

Chest pain or discomfort
Shortness of breath
Irregular heartbeat
Lightheadedness or fainting
Nausea or vomiting
Sweating or clamminess
Anxiety or depression

These symptoms can be similar to those of a heart attack, and they can last from a few minutes to several hours.

However, unlike a heart attack, Takotsubo syndrome usually does not cause permanent damage to the heart muscle, and it can resolve on its own within days to weeks.

What Are the Risk Factors for Takotsubo Syndrome?

The exact causes of Takotsubo syndrome are not fully understood, but there are several risk factors that have been identified, including:.

Females are more commonly affected than males.
Older age may increase the risk.
A history of neurological or psychiatric disorders may be a predisposing factor.
A history of physical or emotional stress may trigger an episode.
A history of cancer or chemotherapy may increase the risk.
A history of smoking, alcohol abuse, or drug use may aggravate the condition.

It is important to note that Takotsubo syndrome can occur in people with no obvious risk factors and can affect people of any age or gender.

What Is the Connection Between Takotsubo Syndrome and Cancer?

There are several ways in which Takotsubo syndrome may be linked to cancer, both as a risk factor and as a consequence.

Takotsubo Syndrome as a Risk Factor for Cancer

Recent studies have found that Takotsubo syndrome may be associated with an increased risk of cancer, particularly in women.

One study published in the Journal of the American Heart Association in 2016 analyzed data from more than 1,600 patients with Takotsubo syndrome and found that they had a 2.5 times higher incidence of cancer compared to the general population.

Another study published in the European Heart Journal in 2018 analyzed data from more than 1,000 patients with Takotsubo syndrome and found that they had a 4 times higher incidence of breast cancer compared to the general population.

However, this association was not observed for other types of cancer, such as lung, gastrointestinal, or gynecological cancer.

The exact mechanisms underlying the association between Takotsubo syndrome and cancer are not clear, but several theories have been proposed.

One theory is that the stress hormones released during an episode of Takotsubo syndrome may promote the growth and spread of cancer cells by stimulating blood vessel formation and immune system dysregulation. Another theory is that the emotional and physical stress that precedes Takotsubo syndrome may be a manifestation of an underlying cancer, which has not yet been diagnosed.

Takotsubo Syndrome as a Consequence of Cancer and Its Treatment

There is also evidence that Takotsubo syndrome can occur as a consequence of cancer and its treatment, particularly chemotherapy.

Chemotherapy is a common treatment for cancer that can cause various side effects, including cardiotoxicity, which can damage the heart muscle and lead to Takotsubo syndrome.

A study published in the Journal of the American College of Cardiology in 2019 analyzed data from more than 18,000 patients with breast cancer and found that those who received chemotherapy had a 38% higher risk of Takotsubo syndrome compared to those who did not receive chemotherapy. The risk was highest during the first 3 months after chemotherapy, but it remained elevated up to 5 years after treatment.

Other cancer treatments, such as radiation therapy, targeted therapy, and immunotherapy, may also increase the risk of Takotsubo syndrome, either directly or indirectly.

How Is Takotsubo Syndrome Diagnosed and Treated?

The diagnosis of Takotsubo syndrome is based on a combination of clinical, imaging, and laboratory criteria.

The clinical criteria include the presence of typical symptoms, such as chest pain, shortness of breath, or syncope, which are not explained by other causes, such as coronary artery disease or valve disease. The imaging criteria include the characteristic shape of the left ventricle on echocardiography, angiography, or magnetic resonance imaging (MRI), which shows a ballooning or apical akinesis of the ventricle.

The laboratory criteria include the absence of significant elevation in cardiac biomarkers, such as troponin, which are commonly elevated in acute coronary syndrome.

The treatment of Takotsubo syndrome is primarily supportive, and it aims to relieve symptoms, prevent complications, and prevent recurrence.

The specific treatment depends on the severity and duration of the symptoms, as well as the presence of underlying conditions, such as cancer or heart failure.

The mainstay of treatment is the use of medications that stabilize the heart muscle and reduce stress hormones, such as beta-blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors), or aldosterone antagonists.

In severe cases, mechanical support devices, such as intra-aortic balloon pumps or ventricular assist devices, may be necessary. However, these devices are rarely used in Takotsubo syndrome, as the condition usually resolves spontaneously.

Preventing Takotsubo syndrome involves reducing the risk factors that are known to trigger or aggravate the condition, such as stress, smoking, alcohol, or drug abuse, and treating any underlying conditions, such as cancer or psychiatric disorders.

Conclusion

Takotsubo syndrome is a relatively new and poorly understood condition that can have serious consequences, including heart failure, recurrent episodes, and even death.

The connection between Takotsubo syndrome and cancer is complex and bidirectional, as Takotsubo syndrome can be a risk factor for cancer, and cancer and cancer treatments can be a risk factor for Takotsubo syndrome.

Therefore, patients with Takotsubo syndrome should be closely monitored for the development of cancer, and patients with cancer should be aware of the possibility of Takotsubo syndrome as a potential complication of their treatment.