When people talk about having a “broken heart,” they’re more often than not referring to it in the metaphorical sense. However, for some, a broken heart is a very literal, physical condition.
Also known as stress-induced cardiomyopathy, broken heart syndrome is a sudden, severe dysfunction of the heart’s left ventricle, which is the heart’s main pumping chamber and is responsible for carrying oxygen-rich blood throughout the body.
It is often mistaken for a heart attack because it shares many of the same symptoms, such as chest pain, shortness of breath and changes in heart function and typically occurs after an emotionally or physically distressing event, such as the loss of a loved one, extreme stress or severe shock. However, unlike a heart attack, which is commonly caused by blocked coronary arteries, broken heart syndrome is typically temporary, treatable and reversible.
“You wouldn’t believe that some intense emotional and physical stressors can cause (broken heart syndrome), but it can even be minor things, which can put you at extreme levels of stress,” says Dr. L Bindu Chebrolu, medical director of cardiology and cardiac imaging at Houston Methodist Pearland Comprehensive Care Center.
[Read: A Patient’s Guide to Heart Disease.]
Broken Heart Syndrome Symptoms
Symptoms of broken heart syndrome are similar to a heart attack.
These symptoms include:
— Chest pain
— Dizziness
— Excessive sweating
— Irregular heartbeat
— Shortness of breath
While most people fully recover from broken heart syndrome, it can — in rare cases — lead to death.
[READ How to Assess Your Heart Health]
Causes of Broken Heart Syndrome
Broken heart syndrome occurs when a person experiences extreme and severe emotional or physical trauma, which triggers a surge of catecholamine hormones, including adrenaline, in the body.
“This adrenaline can actually … directly cause myocardial injury and damage the heart,” Chebrolu says.
As a result, the heart’s left ventricle balloons and causes the coronary arteries that supply blood to the heart to malfunction.
Examples of stressful events that may cause stress-induced cardiomyopathy include:
— Grief over the loss of a loved one
— Intense fear
— Traumatic events, such as car accidents or natural disasters, like wildfires
— Bad news
— Extreme pain
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.
[READ: 6 Ways to Deal With the Loss of a Pet]
Risk Factors for Broken Heart Syndrome
Stress-induced cardiomyopathy can happen in anyone, but certain factors can increase your risk:
— Gender. Broken heart syndrome is more prevalent among menopausal and post-menopausal women. This may happen because of hormonal fluctuations related to menopause (such as a decrease in heart-protective estrogen) along with the sizable adrenaline response that could occur from emotional or physical stress.
— Anxiety and depression. People who have a history of anxiety and depression are more susceptible to broken heart syndrome because of their exaggerated sympathetic nervous system response to stress compared to others.
— Emotional stress. Both men and women can experience this, but more women are likely to have broken heart syndrome if they experience emotional stress. This is likely due to the hormonal fluctuations.
— Physical stress. People who experience stressful physical events, such as surgery or a serious accident, are more likely to have broken heart syndrome.
[Understanding the Signs of a Heart Attack in Women]
Diagnosing Broken Heart Syndrome
Because broken heart syndrome is sudden, ER doctors are usually the first to see patients who experience the condition.
“The ER doctor has a good idea when he or she sees someone … and can make a good assessment of whether this patient has atherosclerotic heart disease,” says Dr. Stephanie Coulter, founding medical director of the Women’s Center for Heart & Vascular Health and assistant medical director of the Texas Heart Institute. “The patients who show up with takotsubo (cardiomyopathy) … don’t have atherosclerotic heart disease, so they don’t have hypertension, smoking, diabetes or obesity.”
Because broken heart syndrome and heart attacks are virtually indistinguishable, health care professionals need to run certain tests to properly and accurately diagnose the condition.
“It’s clinically hard to differentiate a patient who’s having an acute heart attack from takotsubo cardiomyopathy or heart failure,” Chebrolu says. “Medically, testing is what makes the difference to determine whether it’s a true heart attack or if it’s broken heart syndrome.”
Diagnostic tests for broken heart syndrome include:
— Echocardiogram. This imaging test uses ultrasound to capture images of the heart’s structure and function, allowing doctors to detect the ballooning of the left ventricle during an episode of broken heart syndrome.
— Electrocardiogram (ECG or EKG). This test records the heart’s electrical activity and is used to detect abnormalities that mimic a heart attack.
— Coronary angiogram. This imaging test uses a catheter that is inserted through an artery into the heart to inject a contrast dye that allows doctors to check for blockages in the coronary arteries on X-ray images. If a person experiences broken heart syndrome, there is no blockage in the arteries.
— Cardiac MRI. This imaging test uses magnetic fields and radio waves to produce high-resolution images of the heart’s structure and function, which can help doctors confirm the diagnosis or rule out other conditions.
— Blood tests. A test can help doctors test for elevated levels of cardiac enzymes, such as troponin, in the blood.
These tests are performed in addition to taking the patient’s medical history to check for previous heart disease symptoms and talking to the patient about any recent emotional or physical stressors that have happened.
Broken Heart Syndrome Treatments
While there is no standard treatment for broken heart syndrome, several medications used to treat heart failure.
These medications include:
— Beta-blockers (like bisoprolol and carvedilol)
— ACE inhibitors (like ramipril and enalapril)
— Diuretics
“Once we rule out other important conditions, then we tailor the treatment to broken heart syndrome,” Chebrolu says. “We still put them on medication — like any heart failure patient — if the heart function doesn’t recover, and we still put them on mechanical support and all the other treatment therapies if they don’t respond to regular ones.”
Most people fully recover from broken heart syndrome in one to four weeks. Initially, you may stay in the hospital
for a few days for observation before going home to continue your recovery. During this time, you will be advised to avoid strenuous activity.
Some people who have broken heart syndrome 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.
There could be other subtle or recurrent issues with heart function in the future after having an episode.
Broken Heart Syndrome Prevention
Broken heart syndrome has been shown to recur in about 5% of those who’ve had it before, so it’s important to know how to recognize triggers and manage stress to prevent another episode from occurring.
While there’s no specific way to prevent broken heart syndrome, experts say that managing stress is critical.
“This brain-heart connection highlights the importance of mental well-being for heart health,” Chebrolu says. “These days, when you look at one of the major risk factors for heart disease, it’s stress.”
— Stress management. Learning how to cope with your stress triggers and managing them through meditation, deep breathing, stress-relieving exercise and therapy can help.
— Healthy diet. Eating a heart-healthy diet rich in fruits and vegetables can promote mental health and reduce stress and anxiety.
— Regular exercise. 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).
“I really think that the future of cardiac health is all about mental health. Stress management plays a long-term role in a lot of things, like keeping us grounded and keeping our hormones under control,” Chebrolu 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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Broken Heart Syndrome: Symptoms, Causes and Treatments originally appeared on usnews.com
Update 02/13/25: This story was previously published at an earlier date and has been updated with new information.
