It sounds like something that only happens in Shakespearean tragedies and Nicholas Sparks novels, but grief can actually kill a person. Broken heart syndrome — also called stress-induced cardiomyopathy or takotsubo cardiomyopathy — happens when severe emotional stress causes temporary heart failure, even when your heart is otherwise healthy. Although most people seem to recover quickly, the condition can be fatal.
“Broken heart syndrome is not as uncommon as previously thought. This phenomenon was recognized in 1991 and usually presents as the abrupt onset of chest pain and trouble breathing after significant emtional stress, such as after the death of a loved one or even a surprise birthday party. This can also be triggered by physiologic stress, such as with pneumonia or a seizure,” said Sachin Shah, MD, a cardiologist at Lahey Hospital & Medical Center.
What happens to your heart during stress-induced cardiomyopathy, and when should you seek medical attention?
Signs and Symptoms
Broken heart syndrome is often mistaken for a heart attack, because some of the symptoms are very similar — including sudden, intense chest pain (called angina) and shortness of breath. Both conditions show similar changes in heart rhythm and blood substances on medical tests.
However, with broken heart syndrome, there is usually no evidence of the blocked or clogged arteries that cause most heart attacks. Instead, the condition seems to be caused by a surge of stress hormones that weakens your heart and causes part of it to become temporarily enlarged. That part doesn’t pump well, while the rest of your heart works normally or harder than usual.
Like heart attacks, stress-induced cardiomyopathy can also cause arrhythmias (irregular heartbeats) or cardiogenic shock, a condition in which your heart becomes so weak that it doesn’t pump enough blood to keep your other organs functioning properly.
“Cardiogenic shock can be fatal if it isn’t treated quickly. It occurs in about 10 percent of patients with stress induced cardiomyopathy, based on an international registry. Cardiogenic shock occurs when the heart fails and cannot provide adequate blood flow to the other organs. Shock related to stress-induced cardiomyopathy is difficult to treat and almost half of the cases are fatal,” said Dr. Shah. “It’s the most common reason that people die of heart attacks, and it’s what makes broken heart syndrome potentially life-threatening. Anyone experiencing chest pain and shortness of breath needs medical attention and should call 911 right away.”
Diagnosis and Treatment
Stress-induced cardiomyopathy has only been a recognized diagnosis for about 27 years. Thanks to decades of research, well-trained cardiologists can usually spot the difference between a heart attack.
Broken heart syndrome will show these signs:
Symptoms occur suddenly after intense emotional or physical stress.
Blood and imaging tests show no significant blockages in coronary arteries.
- These tests can produce results that look very similar to a heart attack, therefore an evaluation of the coronary arteries which supply blood to the heart is required to differentiate a heart attack from stress induced cardiomyopathy. Additional evaluations may include, most often, an invasive coronary angiogram, or less often, a CT angiogram.
EKG tests, which record your heart’s electrical activity, don’t look the same as with a heart attack.
Imaging classically shows bulging or inadequate contraction in the lower left heart chamber.
Recovery time is much quicker than with a heart attack (days or weeks, versus months).
If you are diagnosed with stress-induced cardiomyopathy, you might need medication to manage short-term effects such as arrhythmia. There is currently no long-term medical managemant strategy, but many patients remain on cardiac medications even after their heart function normalizes.
“There’s still a lot we don’t know for sure about this condition — from exactly what causes it, to how it affects the heart long-term,” said Dr. Shah. “But it’s safe to say that anyone who has experienced a major cardiac event should develop a relationship with a cardiologist and have routine checkups to ensure the heart recovers and continues to function properly.”