Broken heart syndrome — Is it a psychosomatic disorder? Cameron Lacey a, ⁎, Roger Mulder a , Paul Bridgman b , Bridget Kimber a , Julie Zarifeh c , Martin Kennedy d , Vicky Cameron e a Department of Psychological Medicine, University of Otago, Christchurch, New Zealand b Department of Cardiology, Canterbury District Health Board, Christchurch, New Zealand c Psychiatric Consultation Service, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand d Department of Pathology, University of Otago, Christchurch, New Zealand e Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand abstract article info Article history: Received 13 March 2014 Received in revised form 9 May 2014 Accepted 11 May 2014 Available online xxxx Keywords: Broken heart syndrome Psychiatric risk factors Stress cardiomyopathy Objective: The development of somatoform illnesses is often associated with prior psychiatric illness and life stress. Broken heart syndrome has been associated with a range of stressors and we aimed to investigate if psychiatric illnesses are risk factors for developing broken heart syndrome. Methods: We systematically assessed for antecedent psychiatric risk factors in two groups of cases (people who developed sporadic and earthquake-related broken heart syndrome) and compared them to a control group of healthy volunteers. Results: We found that of the ten psychiatric risk factors examined, only ‘neuroticism’ significantly differed between participants with broken heart syndrome and healthy volunteers. Conclusion: There was no association between previous psychiatric illness and development of broken heart syndrome in this study. Clinical assessment of psychiatric risk factors may not identify patients at increased risk of broken heart syndrome. © 2014 Elsevier Inc. All rights reserved. Introduction Broken heart syndrome is also known as stress cardiomyopathy (SCM), or takotsubo cardiomyopathy and is a recently recognised con- dition that is proposed to be associated with psychiatric illnesses [1]. The condition is characterised by onset of symptoms mimicking coro- nary heart disease and is commonly linked with experience of signifi- cant stress [2]. A variety of emotional and environmental stressors, including significant earthquakes have been associated with this condition [1,3]. The precise aetiology of SCM remains unknown, howev- er psychiatric illnesses, such as chronic anxiety disorders, have been proposed as risk factors for the development of SCM [1,4–6]. The Christchurch earthquake sequence in 2010–2011 repeatedly exposed the entire population of Christchurch city, some 350,000 people, to major stress and life disruption. There was an increase in the incidence of SCM following the earthquakes, however the condition remained rare despite the number of people exposed to this stressor [7]. This led us to hypothesise that there is no difference in antecedent psychiatric risk factors between participants who develop earthquake- related and sporadic SCM compared to age-matched healthy controls. Method A case–control study was performed amongst people who devel- oped sporadic and earthquake-related SCM (sp-ECM and eq-SCM). The definition of SCM used was similar to the modified Mayo criteria. All patients were admitted with chest pain with evolving ECG changes, a troponin I rise N 0.03 μg/l and a recognised transient echocardiographic regional wall motion abnormality (apical ballooning pattern, mid-wall variant or basal segment variant). Mean time to follow up echocardio- gram was 10 weeks. 93% (25/27) eq-SCM participants and 74% (23/ 31) sp-SCM received cardiac catheterization during the index event. We retrospectively identified thirty patients with eq-SCM who were admitted to Christchurch Hospital within one week after either the Sep- tember 2010 or February 2011 earthquakes (Richter scale magnitude ≥ 6.3). Patients with sp-SCM were retrospectively identified from Christchurch Hospital records from 2000–2012 with onset of SCM not related to experience of an earthquake. The control cohort was selected from the Christchurch Healthy Volunteers for The Study of Heart Disease (HV), who had been exposed to the same earthquake stressor, attempting to match for age, ethnicity and gender. All 26 control participants had normal echocardiography and ECG. Participants were recruited and assessed in 12 months following the Canterbury Earth- quakes. The Southern Health and Disability Ethics Committee approved this study. Journal of Psychosomatic Research xxx (2014) xxx–xxx ⁎ Corresponding author. Tel.: +64 3 3720400; fax: +64 3 3720407. E-mail address: cameron.lacey@otago.ac.nz (C. Lacey). PSR-08814; No of Pages 3 http://dx.doi.org/10.1016/j.jpsychores.2014.05.003 0022-3999/© 2014 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Journal of Psychosomatic Research Please cite this article as: Lacey C, et al, Broken heart syndrome — Is it a psychosomatic disorder? J Psychosom Res (2014), http://dx.doi.org/ 10.1016/j.jpsychores.2014.05.003