Broken Heart Syndrome

What is 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. When part of your heart isn’t working well, the other parts may work harder.

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.

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 broken heart syndrome

The four different types of broken heart syndrome are:

• 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 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 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.

How common is this condition?

Broken heart syndrome occurs in about 2% of people who visit a provider for a suspected heart attack. But researchers believe the true number of cases is higher because providers often don’t recognize the condition.

Takotsubo cardiomyopathy mostly affects women, who make up about 89% of reported cases. This is especially likely after menopause (mean age range of 58 to 77).

One possible explanation is that the 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 might be more susceptible to the effects of sudden stress.

What are the symptoms?

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).

Broken heart syndrome vs. heart attack

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 permanent heart damage. And you usually make a fast and full recovery.

What causes broken heart syndrome?

Researchers can’t pinpoint broken heart syndrome causes, but 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. Experts think that these hormones temporarily interfere with your heart’s function.

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

There’s no evidence to suggest that a parent can pass broken heart syndrome down to their children.

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.
• Traumatic events like accidents or earthquakes.
• 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, seizure, stroke, high fever, low blood sugar (hypoglycemia), large blood loss or surgery.

What are the risk factors for broken heart syndrome?

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 a stroke.

What are the complications?

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.
• Hypotension (low blood pressure).
• Abnormal heart rhythm (arrhythmia).
• 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 may order several tests, like:

• A blood test to check for a specific 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 you need coronary angiography to help 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 (takotsubo cardiomyopathy), most people make a full recovery after taking medicine.

Medications for broken heart syndrome treatment include:

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

If your heart needs help pumping, you may need an intra-aortic balloon pump or left ventricular assist device. This is rare.

Complications/side effects of treatment

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

• Allergic or negative reactions to the medications or interactions between medications and other drugs you take.
• Bleeding, infections, blood clots, stroke or a heart attack from a left ventricular assist device or intra-aortic balloon pump.

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.

Can broken heart syndrome be prevented?

There are no known ways to prevent broken heart syndrome. 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 nutritious foods like those in the 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. (Your healthcare provider can guide you to resources to help you quit.)

What can I expect if I have broken heart syndrome?

Broken heart syndrome (takotsubo cardiomyopathy) is a temporary condition for most people. You’ll likely recover without any long-term heart problems.

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.

How long this condition lasts

People usually make a full recovery 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.

Outlook for broken heart syndrome

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.

Although men are less likely to have broken heart syndrome, they’re more likely to have a worse prognosis. This is due to having critical illnesses.

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

It’s unlikely that you’ll die from broken heart syndrome. Estimates of death from it range from 0% to 8%. In most cases, broken heart syndrome is a temporary condition with a full recovery.

How do I take care of myself?

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 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 weeks or years after the first event. The condition happens again in 4% to 10% of people who have it.

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.

If you have any of the symptoms of broken heart syndrome (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.

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?

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.

Is broken heart syndrome serious?

Rarely, yes. People whose condition is severe or unstable will need close monitoring and more advanced types of care, like mechanical support devices.

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