Broken Heart Syndrome
What Is It, Causes, Signs and Symptoms, and More
Author:Maria Emfietzoglou, MD
Editors:Alyssa Haag,Ian Mannarino, MD, MBA,Kelsey LaFayette, DNP, RN, FNP-C
Illustrator:Jessica Reynolds, MS
Copyeditor:Stacy Johnson, LMSW
What is broken heart syndrome?
Broken heart syndrome, also known as Takotsubo syndrome or stress-induced cardiomyopathy, is characterized by rapid heart muscle weakening following severe physical or emotional stress. Signs and symptoms mimic a myocardial infarction (i.e., heart attack). Fortunately, most individuals with Takotsubo syndrome make a full recovery.
What causes broken heart syndrome?
Although the exact cause of broken heart syndrome remains unknown, the condition is considered a reaction to severe emotional or physical stress. Common examples of stressful, emotional events that can lead to broken heart syndrome include the death of a loved one, divorce, a break-up, or losing one's job, home, or money. This condition can also follow positive emotional events, such as a surprise party or winning the lottery. Broken heart syndrome can also be preceded by a highly stressful physical event like a physical altercation or being in a car accident. Additionally, broken heart syndrome can be triggered by physical stressors such as severe pain, running a marathon, an asthma attack, stroke, or surgery. Sometimes, the individual may be unable to identify a preceding stressful event. Additionally, broken heart syndrome can be triggered by physical stressors such as severe pain, running a marathon, an asthma attack, stroke, or surgery. Finally, a significant risk factor is being assigned female sex at birth, as broken heart syndrome is much more common in biological females (>80% of cases). Most women afflicted are post-menopausal with lower estrogen levels, as estrogen is thought to play a cardioprotective role in mitigating the harmful effects of stress hormones.
After an emotionally or physically stressful event, the body releases stress hormones, such as epinephrine, which can interfere with the heart's function by causing arrhythmias (i.e., abnormal heart rhythms) and temporary apical enlargement of the left ventricle. This enlargement of the left ventricle resembles Takotsubo, a Japanese octopus trapping pot with a wide bottom and a narrow neck, which is how this medical condition gets its name.Individuals with broken heart syndrome typically recover fully, with mortality occurring in only 1% of cases. Other rare complications include rupture of the left ventricle, heart failure, and cardiogenic shock.
What are the signs and symptoms of broken heart syndrome?
Signs and symptoms of broken heart syndrome usually start within minutes or hours after exposure to the stressor and often include angina, diaphoresis, nausea, vomiting, or dyspnea. The individual may also have palpitations and low blood pressure.
How is broken heart syndrome diagnosed?
Diagnosis of broken heart syndrome is based on clinical presentation and history of a stressful, emotional, or physical event. An electrocardiogram, or ECG, is also ordered and may reveal abnormal electrical changes similar to those seen during myocardial infarction, such as ST elevation or T wave inversion. Blood tests, including cardiac enzyme levels, such as troponin, may also be performed; in contrast to myocardial infarction, these enzymes are typically normal in broken heart syndrome. Additionally, a coronary angiogram to visualize the coronary blood vessels may be conducted, and unlike in a heart attack, the coronary arteries are typically not obstructed. Ventriculography, or LV gram, may also be performed by injecting contrast into the left ventricle under fluoroscopy to estimate the ejection fraction. In broken heart syndrome, both ventriculography and echocardiography (an ultrasound technique used to visualize the heart) reveal a characteristic ballooning of the lower part of the left ventricle with unusual muscle wall movements. Other imaging studies, such as a cardiac MRI, can help rule out myocardial infarction and confirm the diagnosis.
How is broken heart syndrome treated?
The good news is that broken heart syndrome usually resolves fully with medical management. Treatment can include antihypertensive medications to control the individual’s blood pressure, such as angiotensin-converting enzyme (ACE) inhibitors, beta-blockers to regulate heart rate, and diuretics to maintain normal fluid balance. Anti-anxiety medications or other techniques to manage stress (e.g., psychotherapy, meditation) may also be helpful.
What are the most important facts to know about broken heart syndrome?
Broken heart syndrome, also known as Takotsubo syndrome, is a temporary heart condition that typically follows an emotionally or physically stressful event, such as the death of a loved one or severe physical pain. Signs and symptoms mimic a heart attack and can include angina, nausea, vomiting, or dyspnea. Diagnosis is based on clinical presentation, patient history, EKG, cardiac enzymes, coronary angiography, LV gram, and other imaging studies. Individuals with broken heart syndrome typically recover fully, and treatment often includes ACE inhibitors, beta-blockers, diuretics, and stress management.
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Resources for research and reference
Cleveland Clinic. Broken Heart Syndrome. Retrieved from https://my.clevelandclinic.org/health/diseases/17857-broken-heart-syndrome
MSD manual. Ventriculography (LV gram). Retrieved from https://www.msdmanuals.com/professional/multimedia/image/ventriculography-lv-gram
Mayo Clinic. Broken Heart Syndrome Symptoms and Causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/broken-heart-syndrome/symptoms-causes/syc-20354617
Heart.org. Is Broken Heart Syndrome Real? Retrieved from https://www.heart.org/en/health-topics/cardiomyopathy/what-is-cardiomyopathy-in-adults/is-broken-heart-syndrome-real
BHF. Broken Heart Syndrome. Retrieved from https://www.bhf.org.uk/informationsupport/conditions/cardiomyopathy/takotsubo-cardiomyopathy
Cedars-Sinai. Takotsubo Cardiomyopathy. Retrieved from https://www.cedars-sinai.org/health-library/diseases-and-conditions/t/takotsubo-cardiomyopathy.htmlNORD (National Organization for Rare Disorders). Takotsubo Cardiomyopathy. Retrieved from https://rarediseases.org/rare-diseases/takotsubo-cardiomyopathy/