Broken Heart Syndrome

What is broken heart syndrome?

Broken heart syndrome is a temporary heart condition with symptoms like those of a heart attack. You may think you’re having a heart attack because both conditions cause shortness of breath and chest pain. However, in broken heart syndrome, you don’t have blocked coronary arteries or permanent heart damage. And you usually make a fast and full recovery.

Unlike a heart attack, broken heart syndrome happens when a sudden physical or emotional stressor makes your heart muscle weaken rapidly.

There are many names for and types of broken heart syndrome, including:

• Takotsubo cardiomyopathy.
• Apical ballooning syndrome (or transient apical ballooning syndrome).
• Gebrochenes-Herz syndrome.
• Stress cardiomyopathy (or stress-induced cardiomyopathy).

Are there different types of broken heart syndrome?

Yes, there are four different types:

• Apical. This is the most common type, making up more than 80% of cases. It affects the lower half of your heart.
• Mid-ventricular. This type affects the middle section of your ventricles. The affected area looks like a belt or ring around your heart. The areas of your heart above and below the belt still function as they should.
• Basal. Similar to mid-ventricular, the affected area looks like a ring or belt but is higher up. The area below the belt is the only area that functions normally. This type is very rare and makes up about 2% of cases.
• Focal. This is the rarest type, making up about 1% of cases, and it involves a much smaller area than the other types. The affected area forms a bulge that sticks out noticeably from the rest of your heart. The opposite side of your heart curves inward toward the bulge.

Who gets broken heart syndrome?

According to medical literature, broken heart syndrome (also known as takotsubo cardiomyopathy) occurs in about 2% of people who visit a provider for a suspected heart attack. However, researchers believe the true number of cases is actually higher because providers often don’t recognize the condition.

Broken heart syndrome mostly affects women or people assigned female at birth (AFAB), who make up about 88% of reported cases. This is especially likely after menopause (mean age range of 58 to 77).

One possible explanation is that the female hormone estrogen protects your heart against any harmful effects of hormones your body releases in response to stress. As the level of estrogen declines with age, women or people AFAB might be more susceptible to the effects of sudden stress.

Broken heart syndrome risk factors

You’re more likely to get broken heart syndrome if:

• You’re female or AFAB.
• You’re older than 50 years of age.
• You’ve had a psychiatric disorder such as anxiety or depression.
• You’ve had a neurologic disorder such as seizures or a stroke.

How does this condition affect my body?

A weak heart muscle can disrupt your heart’s supply of blood and its pumping ability. If your heart isn’t pumping effectively, that negatively affects your whole body. Every cell in your body relies on the steady supply of oxygen that your blood carries.

What causes broken heart syndrome?

Researchers don’t fully understand the exact cause of broken heart syndrome. However, they believe a stressful event like a divorce, car accident or job loss can cause it. When you react to physical or emotional stress, your body releases stress hormones in your blood like adrenaline, noradrenaline, epinephrine and norepinephrine. Experts think that these hormones temporarily interfere with your heart’s function.

A small percentage of people with broken heart syndrome (also known as takotsubo cardiomyopathy) can’t identify any stresses that may have triggered their episode.

Broken heart syndrome:

• Disrupts your heart’s normal, steady rhythm (pattern of heartbeats).
• Causes part of your heart to temporarily enlarge (the lower part of your left ventricle).
• Leads to even more forceful contractions in other areas of your heart.

These changes cause temporary heart muscle failure.

What kinds of emotional and physical stress can cause broken heart syndrome?

Examples of sudden emotional stressors include:

• Grief from the death of a loved one or other large or meaningful loss (relationship, home, money or a beloved pet).
• Good news (surprise parties, winning the lottery).
• Bad news.
• Intense fear (public speaking, armed robbery).
• Extreme anger.

Examples of sudden physical stressors include:

• Severe pain.
• An exhausting physical event.
• Health issues, including asthma attacks, difficulty breathing (dyspnea), seizure, stroke, high fever, low blood sugar (hypoglycemia), large blood loss or surgery.

What are the signs and symptoms of broken heart syndrome?

You may feel broken heart syndrome symptoms within minutes up to hours after the stressful event. The release of stress hormones temporarily stuns your heart muscle, producing symptoms similar to a typical heart attack.

Signs and symptoms of broken heart syndrome include:

• Sudden, severe chest pain (angina) — a main symptom.
• Shortness of breath — a main symptom.
• Weakening of the left ventricle of your heart — a main sign.
• Irregular heartbeats (arrhythmias).
• Low blood pressure (hypotension).
• Heart palpitations.
• Fainting (syncope).

What are the complications of broken heart syndrome?

Complications are rare, but may include:

• Pulmonary edema.
• Rupture of the left ventricle of your heart.
• Blockage of the blood flow from your left ventricle.
• Heart failure.
• Blood clot in the wall of your left ventricle.
• Cardiogenic shock.
• Heart block.
• Death.

How is broken heart syndrome diagnosed?

A healthcare provider will complete a physical exam and review your medical history. Then, they’ll order several tests, including:

• A blood test to check for a unique enzyme from damaged heart muscle cells.
• An EKG (electrocardiogram).
• Coronary angiography.
• Echocardiography.
• Chest X-ray.
• Heart MRI (magnetic resonance imaging).
• Ventriculogram (a provider injects dye into your heart’s left ventricle, then takes X-rays that show the size and pumping efficiency of this heart chamber).

Imaging can show damaged heart areas, but angiography can rule out a heart attack. Unlike a heart attack, broken heart syndrome doesn’t involve blocked arteries in your heart.

What is the treatment for broken heart syndrome?

Although there’s no cure for broken heart syndrome (also known as takotsubo cardiomyopathy), most people make a full recovery after taking medicine. Medications include:

• Aspirin to improve circulation and prevent blood clots.
• ACE (angiotensin-converting enzyme) inhibitors or ARBs (angiotensin receptor blockers) to lower blood pressure and fight inflammation.
• Beta-blockers to slow your heart rate.
• Diuretics to decrease fluid buildup.

How soon after treatment will I feel better?

Most people with broken heart syndrome start to feel better as they receive treatment. That can happen while you’re in the hospital or within hours or days of receiving treatment.

Is broken heart syndrome serious?

Rarely, yes. People whose condition is severe or unstable will need close monitoring and more advanced types of care. If your heart needs help pumping, you may need a mechanical support device. This is rare.

Depending on how weak your heart muscle is, your healthcare provider may also recommend cardiac rehabilitation.

Complications/side effects of the treatment

In general, some of the possible side effects of treatment include:

• Medications. Allergic or negative reactions to the medications or interactions between medications and other drugs you take.
• Mechanical support devices. Bleeding, infections, blood clots, stroke and heart attack.

Can broken heart syndrome be prevented?

There are no known treatments for preventing broken heart syndrome (also known as takotsubo cardiomyopathy). However, learning stress management and problem-solving techniques can help you limit physical and emotional stress.

Relaxation techniques can also be helpful. Some examples include:

• Practicing yoga, meditation, journaling or mindfulness.
• Taking a warm bath.
• Lighting scented candles.
• Taking long, deep breaths and slowly exhaling.

Depending on the source of your stress, you may be able to join a support group to talk about your stress and share coping skills. A professional counselor can help, too.

In addition, healthy habits can help you manage physical or emotional stress. These habits include:

• Eating a healthy diet, such as the Dash diet or Mediterranean diet.
• Getting regular exercise (at least five times a week for 30 minutes).
• Getting seven to nine hours of sleep each night.
• Spending time with others.
• Keeping your medical appointments for checkups and screenings.
• Avoiding tobacco product use, recreational drug use and excessive alcohol use. (If you currently use these substances and want to quit, your healthcare provider can guide you to helpful resources.)

Does broken heart syndrome heal?

Yes. Broken heart syndrome (also known as takotsubo cardiomyopathy) is a temporary condition for most people. You’ll likely recover without any long-term heart problems because your heart muscle doesn’t have permanent damage. People usually make a full recovery a few days to a few weeks after a stress-induced event.

If an ongoing health problem — like stroke, asthma or seizures — triggered your broken heart syndrome event, check with your healthcare provider for help managing these health issues.

In some cases, your provider may want to do a follow-up echocardiogram about four to six weeks after your event. They’ll want to make sure you don’t have any heart health problems and the left ventricle of your heart is working normally again.

Can you die from broken heart syndrome?

It’s highly unlikely that you’ll die from it. Death from broken heart syndrome is an extremely rare event (about 1%). In most cases, broken heart syndrome is a short, temporary condition with a full recovery.

However, some people have long-term (or even permanent) effects from this condition. Many people have low energy levels for a number of months after getting broken heart syndrome.

How do I take care of myself?

If you have broken heart syndrome, the best thing to do to take care of yourself is to take your medication and see your provider as recommended. These are both important because of the long-term risks that come with takotsubo cardiomyopathy. You can get broken heart syndrome again or have other health problems months or years after the first event.

When should I see my healthcare provider?

Contact your provider if you notice any new symptoms or changes in existing symptoms, especially if they affect your normal routine. Otherwise, your provider will schedule follow-up appointments as needed.

When should I go to the ER?

Because broken heart syndrome shares symptoms with a heart attack, you should go to a hospital if you have any heart attack symptoms. Those include:

• Chest pain (angina).
• Trouble breathing or shortness of breath.
• Unexpected fainting or passing out, or multiple instances where you become dizzy and nearly pass out.
• Heart palpitations.
• An unusually slow or fast heartbeat or one that skips or adds beats.

What questions should I ask my doctor?

Questions you may want to ask your provider include:

• How long do I need to take the medicines you prescribed for me?
• Do I need any follow-up testing?
• How often do I need follow-up appointments with you?

What should I do if I think I have symptoms of broken heart syndrome?

If you have any of the symptoms of broken heart syndrome (also known as takotsubo cardiomyopathy), seek emergency care. Tests are the only way to know if you’re experiencing broken heart syndrome, a heart attack or another medical issue.

Can my children inherit broken heart syndrome?

There’s no evidence to suggest that broken heart syndrome is hereditary (passed down from parents to children).

Does day-to-day stress from ordinary life cause broken heart syndrome?

Most likely, no. Symptoms start after a sudden or extremely stressful event. If you have frequent chest pain or shortness of breath when facing day-to-day moderate stress, see your healthcare provider.

Ongoing symptoms are usually not a sign of broken heart syndrome. Your provider can help you figure out how to cope with stress, prescribe medication if anxiety is a problem or order tests if they suspect an undiagnosed health problem.

If I’ve had one episode of broken heart syndrome, am I likely to have more?

The risk of recurrence is approximately 4%, or 1 in 25. For this reason, it’s very important to continue taking your medications as your cardiologist or primary care physician directs.

A note from Cleveland Clinic

It’s common to hear people talk about a “broken heart” when they’re talking about their emotions. But broken heart syndrome is real and can happen after sudden emotional or physical stressors affect you.

The good news is that it’s a temporary condition that doesn’t cause any permanent heart damage. However, because its symptoms mimic a heart attack, never try to self-diagnose and convince yourself that you have broken heart syndrome. Always get checked at an emergency care center. Only tests can determine if your heart symptoms are a heart attack, broken heart syndrome or some other health issue.