There are several different types of cardiomyopathy, which is a disease of the heart muscle. Stress-induced cardiomyopathy is a sudden, severe dysfunction of the heart’s left ventricle. This is the heart’s main pumping chamber, and it carries oxygen-rich blood throughout the body.
Stress-induced cardiomyopathy imitates a heart attack, but it’s not a heart attack. It’s treatable and reversible. It’s often caused by a major, stressful event that creates a surge of catecholamine hormones (which include hormones like adrenaline) in the body. The hormone surge causes the left ventricle to balloon, or get bigger, and then coronary arteries that supply blood to the heart don’t function as they should.
Stress-induced cardiomyopathy is considered a type of heart failure. Heart failure is when the heart doesn’t pump blood as effectively as it should.
Stress-induced cardiomyopathy is also called broken heart syndrome, or Takotsubo syndrome. The latter name comes from Japan, where the condition was first recognized in the 1990s. It was named for the Japanese octopus traps called takotsubo, which have a very similar shape to a heart affected by this type of condition.
Broken Heart Syndrome Symptoms
Symptoms of broken heart syndrome, or stress-induced cardiomyopathy, include:
— Chest pain.
— Shortness of breath.
Seek emergency care if you or someone you’re with has these symptoms. You never know if it’s a real heart attack or stress-induced cardiomyopathy, says Dr. Aseem D. Desai, a cardiologist with Providence Mission Hospital Mission Viejo in Mission Viejo, California.
In rare cases, it can cause death. Yet most people recover fully from it.
Causes of Broken Heart Syndrome
Some of the stressful events that may provoke stress-induced cardiomyopathy include:
— Experiencing a natural disaster.
— The loss of a loved one.
— A high fever.
— A serious accident.
— A sudden illness.
However, this type of cardiomyopathy isn’t limited only to those events, other stressors can trigger it. In some cases, there’s no apparent cause.
In 2020, when the COVID-19 pandemic first emerged, the number of stress-induced cardiomyopathy events increased, according to a study from the Cleveland Clinic published in JAMA Network Open in 2020. The researchers found a 1.5% to 1.8% incidence of stress-induced cardiomyopathy before the pandemic, and a 7.8% incidence from March to April 2020, when the pandemic ramped up in the U.S.
Diagnosing and Treating Broken-Heart Syndrome
There are a few tests that doctors use to help diagnose broken-heart syndrome:
— Left heart catheterization. This involves placing a thin tube in the heart’s left side to view the heart and arteries. The doctor can take X-ray pictures during a catheterization.
— Clinical history.
— An echocardiogram (a cardiac ultrasound).
— An electrocardiogram, or EKG, which records the heart’s electrical signals.
— Lab work.
— Talking to the patient or family members about any recent emotional or physical stressors that have happened.
If you experience broken-heart syndrome, you may have abnormal changes on your EKG or abnormal blood tests just as someone with a heart attack would have, says Dr. Glenn N. Levine, master clinician and professor of medicine at Baylor College of Medicine and chief, cardiology section, at Michael E. DeBakey VA Medical Center in Houston. However, catheterization often will show there’s no artery blockage that can cause a heart attack.
A person diagnosed with stress-induced cardiomyopathy typically will receive different types of medications to help their injured heart. These may include beta-blockers (like bisoprolol and carvedilol) and ACE inhibitors (like ramipril and enalapril) among other types of medications. These medications help reduce strain on your heart until you fully recover, Desai says.
Diuretics are used if there are any signs of fluid buildup, says Dr. Jennifer Wong, a cardiologist and medical director of non-invasive cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, California. These may help the heart pump better. Some patients receive anti-anxiety medication to lower the chance of another cardiomyopathy episode.
Recovery from stress-induced cardiomyopathy typically takes one to four weeks. You may stay in the hospital for a few days and then be sent home to rest some more. You may be told to avoid strenuous activity during your recovery. Most people fully recover.
Some people who have stress-induced cardiomyopathy go on to develop longer-term heart failure. This condition requires regular medication use and monitoring by a heart failure specialist. Although heart failure is a serious condition, it’s possible to live a full life with heart failure with the right medications and lifestyle management, according to the American Heart Association.
There could be other subtle or recurrent issues with heart function in the future after having a stress-induced cardiomyopathy episode. Doctors are still gaining a better understanding of these, Dr. Susan Cheng, Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science at Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles.
Who Gets Stress-Induced Cardiomyopathy?
Stress-induced cardiomyopathy can happen in anyone, but it’s more prevalent in women in their 50s, 60s and early 70s. This may happen because of hormonal fluctuations related to menopause (such as a decrease in heart-protective estrogen) along with the sizeable adrenaline response that could occur from emotional or physical stress, says Dr. Ahmad Iqbal, an advanced heart failure cardiologist with Memorial Hermann The Woodlands Medical Center in The Woodlands, Texas.
After the mid-70s, the excess surge in stress hormones is either not as high or not as effective at impacting the heart, Cheng says.
An October 2021 research letter published in the Journal of the American Heart Association from Cheng and colleagues reported that stress-induced cardiomyopathy is on the rise in women ages 50 to 74 years old. In addition to biology, the general aging of the population, as well as more environmental stressors, may contribute to its rise, Cheng says. There also appears to be better recognition of stress-induced cardiomyopathy among doctors. That’s led to more awareness of when it occurs in both men and women, Levine adds.
Preventing Stress-Induced Cardiomyopathy
There’s no specific way to prevent broken-heart syndrome, although doing what you can to manage stress may help. “Focusing on your overall health, both physically and mentally, is extremely important,” Desai says. Healthy heart practices include:
— Learning how to cope with your stress triggers, or avoid them when possible.
— Eating a healthy diet rich in fruits and vegetables.
— Exercising regularly (current guidelines recommend at least 150 minutes of heart-pumping exercise each week, which you can break down to 30 minutes, five days a week).
— Recognizing when you’re stressed and making moves to cope, such as yoga, deep breathing or meditation.
In most patients, stress-induced cardiomyopathy happens only once. It recurs in only about 5% of those who’ve had it before, Iqbal says. If you’ve been prescribed medications because you’ve had a cardiomyopathy incident, don’t stop them unless your doctor says so. Stopping your meds can increase the risk of a repeat event.
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Update 06/20/22: This story was previously published at an earlier date and has been updated with new information.