Broken heart syndrome, officially known as Takotsubo cardiomyopathy, is a specific heart disease that primarily affects postmenopausal women. This condition goes by several other names, including stress or stress-induced cardiomyopathy.
Unlike other heart diseases, broken heart syndrome is caused by a temporary weakening of the left ventricle, the heart’s main pumping chamber. This weakness is often caused by severe mental or physical stress.
The name “takotsubo” comes from the Japanese word meaning octopus catcher and resembles the shape the left ventricle assumes during the onset of heartbreak syndrome, a bulging shape at the bottom.
A difficult aspect of heartbreak syndrome is that it can cause significant but temporary myocardial failure. On the bright side, this condition is generally treatable. Most people affected by broken heart syndrome recover completely within a few weeks.
People with broken heart syndrome may initially have symptoms similar to a heart attack. The most frequent symptoms of broken heart syndrome are:
In some cases, patients may experience signs of heart failure, fast or slow heart rhythms, arrhythmia, sudden cardiac arrest, or severe leakage of one of the heart valves, also known as severe mitral regurgitation.
In addition, patients may have mild stroke or symptoms similar to stroke-like symptoms. This occurs when a blood clot forms in the heart and breaks off, blocking blood flow. About 10% of people who suffer from broken heart syndrome may experience cardiogenic shock, a serious condition in which the heart suddenly stops pumping enough blood to meet the body’s needs.
The exact cause of broken heart syndrome is still unknown, but it is believed that the body’s nervous system is involved. Stress releases hormones such as epinephrine and noradrenaline, which are released during the stress response, which can cause myocardial damage and affect the small blood vessels of the heart. High levels of these hormones can cause spasms in the heart’s blood vessels, ultimately leading to a temporary weakening of the heart muscle.
This condition usually occurs after a period of extreme stressors in life. Triggers for this condition are usually emotional or physical in nature. The most frequent physical triggers are events such as surgery or severe breathing difficulties (acute respiratory failure). Emotional triggers include loss of a loved one, conflict in relationships, fear, anger, and anxiety.
However, it’s important to note that the line between physical and emotional triggers can often blur. Situations such as surgery or acute respiratory failure can be stressful both mentally and physically.
Risk factor
Broken heart syndrome is becoming more common over the years, and although it affects both men and women, it is much more prevalent in women. Women account for the majority of all cases, especially those over the age of 50. There is a marked increase in the number of cases among middle-aged and older women compared to young women. Broken heart syndrome is also on the rise in men, but it’s not as pronounced as in women.
Certain criteria are taken into account when diagnosing broken heart syndrome. First, your health care provider will complete a physical exam. During the exam, your primary care provider may hear a heart murmur. In addition to a physical examination, your health care provider may order some of the following tests to confirm the diagnosis.
- Electrocardiogram (ECG): An electrocardiogram (ECG) is a simple, non-invasive test that records the electrical activity of the heart. In heartbreak syndrome, the electrocardiogram may show a pattern similar to that seen in pericarditis, which involves inflammation of the outer layer of the heart. It may also display patterns that mimic a heart attack.
- Clinical examination: When diagnosing broken heart syndrome, certain blood tests may be ordered. Blood tests may show elevated levels of cardiac biomarkers (molecules that can signal abnormal processes or disease) such as troponin. These are substances released when the heart is damaged.
- Echocardiogram: An ultrasound examination of the heart, known as an echocardiogram, can reveal specific patterns in the movement of the heart muscle. The most common type of broken heart syndrome is the “apical type,” in which the base of the heart swells.
- Magnetic Resonance Imaging (MRI): A cardiovascular MRI scan may be used if the ultrasound results are equivocal or if other heart conditions are suspected. This scan provides a more detailed view of the heart’s structure and can show inflammation, scarring, or other changes in the heart muscle.
- Cardiac catheter: Cardiac catheterization, an invasive procedure, is often used when symptoms are severe. This test involves inserting a tube into a blood vessel in the heart and taking pictures. It usually shows that the arteries are normal or have non-obstructive plaque buildup, which can help confirm the diagnosis of broken heart syndrome.
Initially, your health care provider may give you treatments such as aspirin or drugs that slow your heart and relax your blood vessels. They may also offer medications to lower cholesterol. In addition to medication, your health care provider may also perform additional tests, such as a coronary angiogram, to check for blockages in your heart’s arteries.
Treatment plans vary depending on your condition and specific heart function. For people whose symptoms are stable, health care providers often prescribe blood pressure and cholesterol medications for a short period of time. During this time, your heart’s movement and ability to pump blood will be checked regularly to see if your condition is improving.
Blood thinners are given to people who have a blood clot in their heart or who have a blood clot-related complication, which occurs in about 5% of cases. If a patient’s condition is more severe or in cardiogenic shock, health care providers may use stronger drugs to make the heart pump more effectively. Some patients may need mechanical support to help the heart pump.
Broken heart syndrome often occurs after a highly stressful event. To lower your risk of this condition, it’s important to prioritize both your heart health and your stress levels. Discussing the signs, symptoms, and treatment options for existing heart disease with your health care provider is a proactive step.
Managing stress involves a variety of strategies. The Centers for Disease Control and Prevention (CDC) recommends increasing physical activity as a great start to caring for your heart and reducing stress. Habits like deep breathing exercises and meditation can also help reduce stress. It has also been suggested that building strong social networks, getting enough sleep, and limiting alcohol intake are effective ways to manage stress.
The main complications that can arise from broken heart syndrome include various heart-related problems. These include:
- Blockage of blood flow out of the heart, called left ventricular outflow tract obstruction
- Dangerously irregular heart rhythms called ventricular arrhythmias
- atrial fibrillation
- Low blood pressure
- Cardiogenic shock, or severe heart failure that causes poor blood circulation
- heart failure
- Thromboembolism, or the formation of a blood clot that travels through the bloodstream and causes a blockage
Most people who experience broken heart syndrome recover well, but the time it takes to recover varies from person to person. Although many patients recover, a minority may face more serious complications.
It is important that each individual follows a recovery plan that is tailored to their specific needs and circumstances. This may include joining a support group for people with broken heart syndrome who can provide emotional and practical support. Additionally, members of your medical team, such as cardiac nurses, can provide information about specialized cardiac rehabilitation classes aimed at aiding the recovery process and improving your overall heart health.
