Is Broken Heart Syndrome Real?

Broken heart syndrome may sound like a curse suffered by characters in fairy tales, but it’s actually a very real condition—though fortunately rare. Also known as takotsubo cardiomyopathy or stress cardiomyopathy, broken heart syndrome causes heart attack symptoms in people experiencing a stressful event.

Malissa J. Wood, MD, a Mass General Brigham cardiologist and co-director of the Corrigan Women’s Heart Health Program at Massachusetts General Hospital, describes what to look out for and the importance of managing our response to stress.

What are the causes and symptoms of broken heart syndrome?

“Broken heart syndrome is essentially a chemical heart attack, where we see enzymes in the blood and changes in the heart muscles that look like a heart attack, but there are no blocked arteries like you see in coronary artery disease,” Dr. Wood explains. It happens most commonly in the setting of a very negative stressful event, such as the loss of a loved one. But it can also occur when something very exciting or good happens. More rarely, it can occur during surgery.

The exact cause is unclear, but it’s thought that the hormone adrenaline is involved. The body releases adrenaline in response to stress, and this increases your heart rate. The heart muscles then squeeze very strongly and abnormally, disrupting the function of the heart.

“We think there is a link between adrenaline and hormones associated with emotions and stress, and the way that micro blood vessels in the heart actually deliver blood to the heart and the muscles,” says Dr. Wood.

What are the symptoms of broken heart syndrome?

Symptoms very closely mimic a real heart attack, including:

• Chest pain
• A squeezing or tightening sensation in the chest
• Shortness of breath
• A rapid heart beat
• Sudden lightheadedness

Women with heart disease are more likely than men to have “non-cardiac” symptoms such as pain in the neck, back, and arm.

If you experience the sudden onset of any of these symptoms, call 911.

Who is at risk of broken heart syndrome?

“It’s much more common in postmenopausal women in their seventies and eighties,” Dr. Wood says. “But now that we have a better idea of what it looks like in patients, we’re seeing it in men and younger women as well.”

It’s thought that older women are particularly at risk because they have lower levels of the hormone estrogen, which may affect how the heart arteries respond to stress. “There’s a lot we still don’t know about it, but we’re doing more research to gather data on a genetic and molecular basis,” says Dr. Wood.

How is broken heart syndrome diagnosed?

If you experience the signs of a heart attack, it’s crucial to get immediate medical attention so you can be properly diagnosed. Doctors may use these tests to check for broken heart syndrome:

• Blood tests: Elevated blood enzymes, like troponin, are a sign of heart damage.
• Electrocardiogram(EKG): This test measures the electrical signals of your heart.
• Coronary angiogram or CT scan: Doctors use these tests to examine the heart’s blood vessels.

“Usually there will be a patient history to tip us off to the fact that the patient has experienced a stressful event,” says Dr. Wood, “but we need to be sure that the arteries aren’t blocked in order to diagnose them with broken heart syndrome.”

What is the treatment for broken heart syndrome?

Treatment usually involves hospitalization, medication, and further monitoring. “We need to make sure there aren’t any dangerous irregular heart rhythms, which can happen,” says Dr. Wood. “The great news is that people almost always recover completely, with proper medication and rest. Within 3 to five 5 days the heart muscles start to recover.”

Fortunately, recurrence is rare and happens in less than 5% of cases. “We make sure to talk to people who have had broken heart syndrome about managing their stress, learning how to respond to stress in a healthy way and developing resiliency,” Dr. Wood says. Exercising regularly, seeking therapy support for anxiety and depression, starting a meditation practice, and getting enough sleep are all ways to help reduce stress.