Broken Heart Syndrome

Broken heart syndrome is a short-term condition where some of your heart muscle weakens rapidly. This typically happens after a sudden physical or emotional stressor. Chest pain and shortness of breath can make it feel like a heart attack.

A weak heart muscle can disrupt your heart’s supply of blood and its ability to pump. If your heart isn’t pumping well, that harms your whole body. Every cell in your body relies on the steady supply of oxygen that your blood carries. And when part of your heart isn’t working well, the other parts of your heart may work harder.

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

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

Types of this condition

The four different types of broken heart syndrome are:

• Apical: This is the most common type, making up more than 8 out of 10 cases. It affects the lower half of your heart.
• Mid-ventricular: This type affects the middle section of your heart’s lower chambers (ventricles). The affected area looks like a belt or ring around your heart. The areas of your heart above and below the belt still work as they should.
• Basal: Like 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.
• Focal: This is the rarest type, and it involves a much smaller area. 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.

Symptoms of broken heart syndrome

Most often, you may feel broken heart syndrome symptoms within minutes up to hours after the stressful event. These symptoms are like those of a typical heart attack.

Symptoms of broken heart syndrome include:

• Sudden, severe chest pain (a main symptom)
• Shortness of breath (a main symptom)
• Fainting (a main symptom)
• Fast or slow heart rhythms (arrhythmias)
• Low blood pressure (hypotension)
• Heart palpitations

Because broken heart syndrome has symptoms like those of a heart attack, you may think you’re having one. Both conditions cause shortness of breath and chest pain. But with broken heart syndrome, you don’t have blocked coronary arteries and typically don’t have lasting heart damage. And you usually make a fast and full recovery.

Broken heart syndrome causes

Researchers think adrenaline and other chemicals your body makes during stress are the cause. When you react to physical or emotional stress, your body releases stress hormones in your blood. An event like a divorce, car accident or job loss can cause a release of these hormones. Experts think that these hormones stun or injure your heart muscle.

A small percentage of people with broken heart syndrome (Takotsubo cardiomyopathy) can’t name any stressors that may have triggered their episode.

Examples of sudden 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)
• Traumatic events, like accidents or earthquakes
• Intense fear (public speaking, armed robbery)
• Extreme anger
• Severe pain
• An exhausting physical event
• Health issues, including asthma attacks, seizures, stroke, high fever, low blood sugar, large blood loss or surgery

Risk factors

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

• You’re female
• You’re older than 50 years of age
• You’ve had a psychiatric disorder, like anxiety or depression
• You’ve had a neurologic disorder, like seizures or stroke

One possible reason this affects women over 50 is that they may be less protected from the effects of sudden stress as they lose the hormone estrogen. This hormone protects your heart against any harmful effects of other hormones your body releases in response to stress.

How to lower your risk

There are no known ways to prevent Takotsubo cardiomyopathy. But learning how to manage stress and solve problems 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 nutritious foods, like those in the Mediterranean diet
• Getting regular physical activity (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 check-ups and screenings
• Avoiding tobacco product use and other substance use

Complications of this condition

Broken heart syndrome complications are rare, but may include:

• Fluid buildup in your lungs (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
• Low blood pressure (hypotension)
• Abnormal heart rhythm (arrhythmia)
• Lack of pumping ability in your heart (cardiogenic shock)
• Heartbeat signal issues (heart block)

How doctors diagnose this condition

A healthcare provider will do a physical exam and review your medical history. Then, they may order several tests to look for weakening of the left ventricle of your heart — a main sign. Tests may include:

• A blood test to check for specific enzymes from damaged heart muscle cells
• EKG (electrocardiogram)
• Coronary angiogram
• Echocardiogram
• Chest X-ray
• Heart MRI
• Ventriculogram (X-rays show the size and pumping efficiency of your left ventricle)

Imaging can show damaged heart areas, but a coronary angiogram can show blocked arteries in your heart. If you don’t have these, it helps rule out a heart attack. Unlike a heart attack, broken heart syndrome doesn’t involve these blockages.

How is it treated?

Although there’s no cure for Takotsubo cardiomyopathy, most people make a full recovery after taking medicine.

Medications for treatment of broken heart syndrome include:

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

If your heart needs help pumping and you’re very sick from this syndrome, you may need an intra-aortic balloon pump or left ventricular assist device. This is rare.

Recovery time

Most people with Takotsubo cardiomyopathy start to feel better as they receive treatment. That can happen while you’re in the hospital or within hours or days of starting treatment.

When should I see my healthcare provider?

Because broken heart syndrome shares symptoms with a heart attack, you should call 911 or emergency services if you have any heart attack symptoms. Those include:

• Chest pain
• Trouble breathing or shortness of breath
• Unexpected fainting, or several instances of dizziness and nearly passing out
• Heart palpitations
• An unusually slow or fast heartbeat or one that skips or adds beats

If you have any of the symptoms of broken heart syndrome, seek emergency care. Tests are the only way to know if you have broken heart syndrome, a heart attack or another medical issue.

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 visits as needed. Your first visit will likely be within three months of diagnosis.

Questions to ask your provider may 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 visits with you?

What can I expect if I have this condition?

Broken heart syndrome (Takotsubo cardiomyopathy) is a short-term condition for most people. You’ll likely recover without any long-term heart problems. People usually make a full recovery in a few days to a few weeks after a stress-induced event.

But many people have low energy levels for months after getting broken heart syndrome. This can lead to depression. If this happens to you, be sure to ask your provider for help.

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.

You can get broken heart syndrome again or have other health problems weeks or years after the first event. 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 that the left ventricle of your heart is working normally again.

People who get broken heart syndrome from a medical issue (like illness or surgery) tend to have a worse outcome than those who get the condition from an emotional event. This is why men are more likely to have a worse prognosis. Although men are less likely to have broken heart syndrome, they’re more likely to get it from a critical illness.

Is there anything I can do to feel better?

You may need to keep taking prescribed medicines for three to six months. If you have broken heart syndrome, the best thing to do to take care of yourself is to take your medication and go to scheduled visits with your provider.

Researchers have linked taking ACE inhibitors or ARBs with better survival.

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 a healthcare provider.

Ongoing symptoms usually aren’t 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.

Is broken heart syndrome serious?

Rarely, yes. If your condition is severe or unstable, you’ll need close monitoring and more advanced types of care. This may include mechanical support devices.

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

It’s unlikely that you’ll die from broken heart syndrome. Estimates of death from it range from 0 to 8 out of 100 people.