A world-first study has found that both cognitive behavioural therapy (CBT) and exercise can successfully treat Takotsuba syndrome, also known as a broken heart.

University of Aberdeen researchers have recently completed the world’s first randomised trial of treatments for the little-known syndrome that is often mistaken for a heart attack, even by medical professionals.

Tending to happen in response to an emotional shock, Takotsuba is caused by the left ventricle of the heart suddenly ballooning, which stops the heart from pumping blood around the body properly and can lead to heart failure.

Scientists believe the phenomenon occurs as a reaction to a surge of adrenaline to the heart after extreme emotional or physical stress, although some cases have no known trigger at all. It causes serious effects to the heart which may not return to normal and patients with Takotsubo syndrome have twice the risk of death compared to the general population. It affects around 5,000 people in the UK each year.

Funded by the British Heart Foundation (BHF), the University of Aberdeen has been studying the illness since 2010. Researcher Professor Dana Dawson says: “It’s fascinating research – this is the strongest interaction of where mental state affects physical health that we know of in medicine.”

The results of the trial – which compared 12 weeks of CBT, 12-weeks of exercise and 12-weeks of the usual care – have recently been presented at the European Society of Cardiology Congress in Madrid.

The study involved 76 patients with Takotsubo syndrome – 91 per cent were women and the average age was 66. Patients were randomly assigned to receive CBT, the exercise programme, or standard care. All participants continued to receive the usual care and treatment recommended by their cardiologist.

The CBT group had 12 one-to-one weekly sessions, specifically adapted to their condition, as well as daily support if needed.

The exercise group completed a structured exercise programme which included cycling machines, treadmills, aerobics and swimming. The number of sessions and intensity were increased each week.

Researchers used a sophisticated imaging technique, called 31P-Magnetic Resonance Spectroscopy, which allowed them to study how patients' hearts were producing, storing and using energy – the heart’s metabolism.

Research had previously shown that patients with Takotsubo syndrome have a significant impairment to how their hearts handle energy and that this persists long term. However, the imaging showed that after 12 weeks of CBT or exercise, there was an increase in the amount of fuel available to patients’ hearts to allow them to pump, which was not seen in people who had the standard care.

The average distance which patients could walk in six minutes also increased, as well as their VO2 max. While the effects were greater in the exercise group, they were also significant in the CBT group.

Average walking distance improvements in the CBT group increased from 402 metres to 458 metres. The exercise programme participants upped their distance from 457 metres to an average of 528 metres. VO2 max in the CBT group increased by 15 per cent and 18 per cent in the exercise group.

In contrast, there was little change in both measures during the trial in the patient group that only received standard care.

Dr David Gamble, clinical lecturer in cardiology at the University of Aberdeen, said in Madrid: “These results further highlight the importance of ‘the brain-heart axis’. It shows that CBT or exercise could help patients along the road to recovery. Both are very cost-effective interventions, and we hope that further studies could lead to them being used to help this underserved group across the country.”

Researchers will now test whether the treatments improve patients’ health, and reduce their risk of dying, over a longer period. They hope that either programme could be recommended on the NHS.

Dr Sonya Babu-Narayan, clinical director and consultant cardiologist at the BHF, said: “People may not be as surprised that an exercise programme helped heart patients, but it is intriguing that this study also showed that cognitive behavioural therapy improved heart function and patients’ fitness.”