Dr Benedicta Quaye, anatomy lecturer at Lancaster University, has warned that menopause symptoms may be masking Takotsubo syndrome, a deadly heart condition. While a racing heart is associated with hormonal changes, it is also a red flag for the life-threatening disease that damages heart muscle and is underdiagnosed by doctors. Scientists warn that symptoms of the condition, also known as broken heart syndrome, can mimic a heart attack and cause confusion among medics.
Writing in The Conversation, Dr Quaye warned that heart palpitations "should not automatically be attributed to hormonal changes." She advised that new, persistent or worsening palpitations should be assessed by a healthcare professional. Palpitations that do not go away or occur with chest pain, shortness of breath, feeling faint or fainting require urgent medical help, she added.
Dr Quaye explained that because Takotsubo syndrome and a heart attack can look "almost identical" at first, patients are often given the wrong treatment. She warned that the acute episode can cause heart failure, blood clots, stroke, shock or cardiac arrest.
Risk factors and triggers
Broken heart syndrome is a real condition that can be life-threatening, with older women at the highest risk. The condition causes a sudden, usually temporary change in how part of the heart muscle contracts, limiting the heart's ability to pump oxygen around the body. While it does not lead to permanent damage in many cases, severe muscle weakness in some patients can lead to stroke, heart failure, irregular heartbeats and cardiac arrest.
Intense emotional stress, such as financial worries or the loss of a loved one, can trigger the syndrome. In one previous case, researchers found a mother developed the condition after an emotional argument with her daughter. Physical injuries, surgery or serious illness can also bring on the syndrome, which experts said shows the "strongest interaction" between mental and physical health they have ever seen.
Many women may live with broken heart syndrome without realizing it. The condition is rare, affecting around 5,000 people in the UK. Dr Quaye suggested that the majority of patients are women aged between 67 and 70, meaning most diagnoses occur in postmenopausal women, though experts noted it can also occur before menopause.
Differences from heart attacks
According to the British Heart Foundation (BHF), broken heart syndrome was only recently distinguished as a separate problem from a heart attack. A heart attack, which strikes someone in Britain every five minutes, occurs when heart muscle cannot receive oxygen because blood flow is blocked by a narrowed or clogged coronary artery. The most common cause of a heart attack is coronary artery disease, which occurs when cholesterol and fatty substances build up in arteries.
Heart attacks have been associated with perimenopause because hormonal changes can contribute to rising cholesterol levels. Menopause also causes levels of oestrogen, one of the body's main female sex hormones, to fall. Lower oestrogen has been linked to a greater risk of heart attacks because it can encourage fatty substances to build up in arteries, but Dr Quaye said a clear link between oestrogen and broken heart syndrome has not been established.
Like heart attacks, broken heart syndrome affects the heart muscle, but it is not believed to be caused by a cholesterol blockage. People with the condition are largely believed to have normal arteries without severe blockages or clots. According to the BHF, the exact cause remains unknown, but experts said it may be related to a "rush of overwhelming stress hormones" such as cortisol or adrenaline.
Diagnosis and treatment
Doctors often need to carry out several tests to distinguish between a heart attack and broken heart syndrome to make the correct diagnosis.
These tests investigate how the heart is pumping, as well as the condition of the arteries and heart muscle. Until test results are available, doctors typically treat patients as though they are having a heart attack to ensure they receive immediate care.
Research funded by the BHF showed that some patients continue to experience symptoms four months after experiencing broken heart syndrome, including extreme fatigue, breathlessness and chest pains. Other studies have found the heart muscle remains swollen for months after the episode, alongside inflammation in the heart and body.
Experts believe applying standard heart attack recovery treatments is not useful because the conditions work in different ways. Current treatments involve administering diuretics to help breathlessness and beta blockers to reduce pressure on the heart. Blood thinning drugs are also sometimes used to reduce the risk of blood clots.
Scientists are investigating whether magnetic resonance imaging (MRI) scans to detect inflammation could help guide future treatments. They have also explored whether drugs that improve the heart's energy production could offer a way to treat the condition.
