Takotsubo syndrome: How the broken heart deals with negative emotions

Abstract

HighlightsTakotsubo patients show lower bilateral superior parietal activity during the processing of negative expected pictures compared to healthy control subjects.Takotsubo patients show lower decoding of negative versus neutral pictures in a widespread network consisting of frontal, parietal, occipital, and cerebellar brain regions.The lower involvement of brain regions observed in Takotsubo patients suggests an impairment in emotional regulation, which might be of etiological importance in this brain-heart disease.

Psychological Characteristics of Patients with Takotsubo Syndrome and Patients with Acute Coronary Syndrome: An Explorative Study toward a Better Personalized Care

“…According to Delmas and colleagues, the pathophysiology of TTS may include an autonomic nervous system dysfunction, that consists in a "downregulation of autonomic modulation by the parasympathetic tone leading to an excessive response to acute sympathetic nervous system stimulation, with fast and complete recovery after the stimulation itself" [26]. A recent neuroimaging study also suggests an impairment in emotion regulation patterns for TTS patients [27]. From the behavioral side, an excessive response to a stressful situation may be due to a scarce ability to cope with stress.…”

Limbic Responses to Aversive Visual Stimuli during the Acute and Recovery Phase of Takotsubo Syndrome

“…Our results are further supported by previous TTS that noted lower thalamic volume [ 2 ] and, in general, the lower functional connectivity of PFC [ 8 ] and the limbic system [ 6 ]. The frontal cortex, involving the dorsolateral PFC and the IFG, were previously noted with a lower involvement during IAPS task-based fMRI in decoding negative versus neutral pictures and lower activity in the bilateral superior parietal lobe when processing negative versus positive expected pictures in the recovery phase of TTS compared to HC [ 13 ]. Our study showed that TTS recovery phase compared to HC had significantly higher mean activity within the left lateral occipital cortex, right middle temporal gyrus, and left lingual gyrus during the decoding of negative versus positive pictures.…”

“…These areas are responsible for fine-tuning emotions, such as anxiety, anger, and stress, as well as the cardiac autonomic balance. In the chronic phase of TTS, previous resting-state and task-based fMRI studies found both a stronger connectivity between the midcingulate cortex and the parasympathetic primary motor area, which are brain areas involved in pain experience regulation and visceromotor control (in comparison to patients with previous acute MI) [ 12 ], as well as lower response of limbic regions during emotional picture paradigm (in comparison to healthy age- and gender-matched control subjects) [ 13 ], respectively.…”

Ventricular fibrillation and Takotsubo cardiomyopathy triggered by media panic on COVID‐19: A case report

“…23 As psychiatric comorbidity is concerned, a recent study showed that emotion regulation in former TTC patients remains impaired even 27 months after event and processing of emotions is different from normal in frontal, parietal, occipital, and cerebellar brain regions. 24 Considering these studies and the history of our patient with anxiety disorder, depression, and acute development of J-wave, we decided to implant a permanent ICD. We should note critically that we did not ask for a psychiatric support, as a treatment for the etiology might help in avoidance of recurrence of such condition.…”

“…However, another working group showed a one‐year mortality of 44% in patients after life‐threatening arrhythmias compared with 10% in patients without arrhythmias 18 and these authors recommend temporary wearing of a cardioverter‐defibrillator vest until ECG and left ventricular function have recovered 23 . As psychiatric comorbidity is concerned, a recent study showed that emotion regulation in former TTC patients remains impaired even 27 months after event and processing of emotions is different from normal in frontal, parietal, occipital, and cerebellar brain regions 24 . Considering these studies and the history of our patient with anxiety disorder, depression, and acute development of J‐wave, we decided to implant a permanent ICD.…”