table of contents
- What is broken heart syndrome?
- What causes broken heart syndrome?
- What are the risk factors of broken heart syndrome?
- What are the signs and symptoms of broken heart syndrome?
- How is broken heart syndrome diagnosed?
- What is the treatment for broken heart syndrome?
- How do you prevent broken heart syndrome?
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
In 2016 the world lost two entertainment icons in quick succession. Actress Carrie Fisher passed away from a heart attack at age 60, and a few days later, her mother, Debbie Reynolds, died at the age of 84 (Carey, 2016). While Reynolds is said to have suffered from multiple health problems in the years leading up to her death and officially died from a stroke, her son, Todd Fisher, told the Associated Press that his sister’s death “was too much” for his mother to handle (Elber, 2016). Reynolds’ seemingly sudden death in the wake of her daughter’s passing left some wondering: is it possible to die of a broken heart?
What is broken heart syndrome?
To put it plainly, yes—there really is such a thing as broken heart syndrome. Otherwise known as takotsubo cardiomyopathy (tako tsubo are octopus traps that look like the “broken” heart), broken heart syndrome is a legitimate diagnosis that can affect anyone—even healthy people (AHA, n.d.). The condition is also sometimes called stress cardiomyopathy, stress-induced cardiomyopathy, or apical ballooning syndrome. While broken heart syndrome is considered a temporary heart condition, it can lead to heart muscle failure and be deadly in some cases (NIH, 2017).
When a person develops broken heart syndrome, a part of their heart called the left ventricle temporarily becomes enlarged and weak. This prevents it from efficiently pumping blood to support the body’s needs. Stress cardiomyopathy is often misdiagnosed as a heart attack because the two conditions have similar symptoms, and people who experience broken heart syndrome may have test results that resemble those of someone who has suffered a heart attack. Someone who has takotsubo cardiomyopathy may have the same kinds of changes in their heart rhythm and markers in their blood that are typical of someone who has had a heart attack. The big difference between the two conditions is that people with broken heart syndrome don’t have blocked arteries around their hearts like people who have heart attacks (AHA, n.d.).
Broken heart syndrome is thought to affect anywhere from 2–10% of all patients with the clinical symptoms of acute coronary syndrome (ACS), otherwise known as a heart attack, myocardial infarction, or unstable angina (Y-Hassan, 2018; Sweis, 2019). Women are more likely to experience broken heart syndrome than men, and the condition most commonly affects postmenopausal women. About 90% of all reported cases of broken heart syndrome have been in women, and the mean age of those affected ranged from 58 to 75 years old (Prasad, 2008).
While the condition is rare, the prevalence of broken heart syndrome is likely underestimated since it can so closely resemble a heart attack.
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What causes broken heart syndrome?
Experts are still learning about the possible causes of broken heart syndrome. In many cases, takotsubo cardiomyopathy appears to be brought on by instances of intense emotional or physical stress (which makes the name, “broken heart syndrome,” appropriate). Very stressful events and emotions like grief, anger, and fear can all potentially trigger a surge of stress hormones and cause broken heart syndrome (Ramaraj, 2007). Positive emotions can cause broken heart syndrome too (think: intense, sudden surprise), and stressful situations and physical stressors like illness, an asthma attack, a stroke, or seizure can be potential causes of broken heart syndrome too.
There is also research that suggests hormone imbalances may play a role in the development of broken heart syndrome, but more research is needed to fully understand the link (Gupta, 2018). Certain medications have also been associated with takotsubo cardiomyopathy, including some antidepressants, thyroid replacement hormones, and allergy medications, but more research is needed to confirm any connection between medication and broken heart syndrome (Izumi, 2013).
A 2019 study found that there may be a connection between broken heart syndrome and cancer (Cammann, 2019). Researchers found that one in six people with takotsubo cardiomyopathy also developed cancer. These people were also more likely to die within five years of their cancer diagnosis, compared to people without broken heart syndrome.
What are the risk factors of broken heart syndrome?
Some people may be more predisposed to developing broken heart syndrome than others, but more research is needed to explore the risk factors. Some data suggests takotsubo cardiomyopathy may involve a genetic connection (UpToDate, n.d.). Other evidence suggests that people with certain psychiatric and/or neurologic disorders may be at a higher risk of developing stress cardiomyopathy. According to the International Takotsubo Registry study, 55.8% of people with stress cardiomyopathy had an acute, former, or chronic psychiatric disorder like an anxiety disorder or a neurologic disorder like a seizure or headache disorder, compared with 25.7 percent of patients with ACS (Templin, 2015).
What are the signs and symptoms of broken heart syndrome?
Broken heart syndrome may resemble a heart attack in some ways, but the two conditions also have some distinct signs and symptoms. The most common signs and symptoms of broken heart syndrome are chest pain and shortness of breath. Anyone with stress cardiomyopathy may experience these symptoms, even if they have no history of heart problems (AHA, n.d.). People with broken heart syndrome may also experience irregular heartbeats (called arrhythmias) and/or a condition called cardiogenic shock, which means their heart becomes too weak and can’t pump enough blood for the body to perform all of its functions. This condition is usually accompanied by symptoms like rapid breathing, sweating, weak pulse, low blood pressure, and it can be fatal if it’s not treated right away.
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How is broken heart syndrome diagnosed?
If your doctor or cardiologist thinks you may be experiencing broken heart syndrome, they may order tests to confirm the diagnosis. One type of test called coronary angiography uses X-rays and dye to show the insides of your coronary arteries. Another type of test that your doctor may order is an echocardiogram, which uses sound waves to create pictures of your heart in motion. Other possible tests include blood tests, electrocardiogram (EKG or ECG) to measure the electrical activity of your heartbeat, and cardiac magnetic resonance imaging (MRI), which uses a magnetic field and radiofrequency waves to create pictures of the inside of your heart.
The test results in people with broken heart syndrome may not look like the test results of people having a heart attack. People with broken heart syndrome may have different EKG readings, and their blood tests may not show any heart damage (but sometimes they do). Test results in people with broken heart syndrome also normally show a ballooning and unusual movement in the left ventricle of the heart, and no signs of coronary artery blockages (AHA, n.d.).
What is the treatment for broken heart syndrome?
There is no single approved medication that treats stress cardiomyopathy, but there are some common practices that doctors use to address it. Some doctors prescribe medications called beta-blockers to help the heart recover. Most people who experience broken heart syndrome will have to stay in the hospital for a day or two while doctors monitor their symptoms, but the condition is usually treatable. Most people with broken heart syndrome make a full recovery in a few weeks (although everyone is different and recovery may take longer for some people), and it’s unlikely for the condition to come back again.
How do you prevent broken heart syndrome?
There’s also no single way to prevent broken heart syndrome from coming back, but the likelihood of it happening again is low. About 10–15% of people who’ve had stress-induced cardiomyopathy can have it again after they’ve made a recovery from the condition. The trigger doesn’t necessarily have to be the same for people who do develop broken heart syndrome more than once. While there’s no single prevention strategy, managing stress may be one important way to keep broken heart syndrome from recurring.
- American Heart Association (AHA). (n.d.) Is Broken Heart Syndrome Real? American Heart Association. Retrieved from https://www.heart.org/en/health-topics/cardiomyopathy/what-is-cardiomyopathy-in-adults/is-broken-heart-syndrome-real
- Cammann, V., Sarcon, A., Ding, K., Seifert, B., Kato, K., Di Vece, D., et al. (2019). Clinical Features and Outcomes of Patients With Malignancy and Takotsubo Syndrome: Observations From the International Takotsubo Registry. Journal of the American Heart Association, 8, e010881. doi: 10.1161/JAHA.118.010881. Retrieved from https://www.ahajournals.org/doi/full/10.1161/JAHA.118.010881
- Carey, B. (2016, December 29). Did Debbie Reynolds Die of a Broken Heart? New York Times. Retrieved from https://www.nytimes.com/2016/12/29/health/did-debbie-reynolds-die-of-a-broken-heart.htm
- Elber, L. (2016, December 28). Actress Debbie Reynolds, 84, dies a day after daughter. AP News. Retrieved from https://apnews.com/1be2ecac3eca4b59bafc2ec46276f4e0/Actress-Debbie-Reynolds,-84,-dies-a-day-after-daughter
- Gupta, S., Goyal, P., Idrees, S., Aggarwal, S., Bajaj, D., & Mattana, J. (2018). Association of Endocrine Conditions With Takotsubo Cardiomyopathy: A Comprehensive Review. Journal of the American Heart Association, 7(19), e009003. doi:10.1161/JAHA.118.009003. Retrieved from https://www.ahajournals.org/doi/10.1161/JAHA.118.009003
- Izumi, Y. (2013). Drug-induced Takotsubo cardiomyopathy. Heart Failure Clinics. doi: 10.1016/j.hfc.2012.12.004. Retrieved from https://www.heartfailure.theclinics.com/article/S1551-7136(12)00117-1/fulltext
- National Institutes of Health (NIH). (2017). Broken heart syndrome. Retrieved from https://rarediseases.info.nih.gov/diseases/9400/broken-heart-syndrome.
- Prasad, A., Lerman, A., & Rihal, C. S. (2008). Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): A mimic of acute myocardial infarction. American Heart Journal, 155(3), 408–417. doi:10.1016/j.ahj.2007.11.008. Retrieved from https://pubmed.ncbi.nlm.nih.gov/18294473/
- Ramaraj, R. (2007). Stress cardiomyopathy: aetiology and management. Postgraduate Medical Journal, 83(982), 543–546. doi:10.1136/pgmj.2007.058776. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600114/
- Reeder, G. S. (2019, June) Clinical manifestations and diagnosis of stress (takotsubo) cardiomyopathy. UpToDate. Retrieved from https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-stress-takotsubo-cardiomyopathy#H4
- Sweis, R. & Jivan, A. (2019). Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina). Merck Manual. Retrieved from https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/coronary-artery-disease/acute-coronary-syndromes-heart-attack-myocardial-infarction-unstable-angina
- Templin, C., Ghadri, J. R., Diekmann, J., Napp, L. C., Bataiosu, D. R., Jaguszewski, M., et al. (2015). Clinical features and outcomes of takotsubo (stress) cardiomyopathy. New England Journal of Medicine, 373(10), 929-938. https://doi.org/10.1056/NEJMoa1406761. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26332547/
- Y-Hassan, S. & Tornvall, P. (2018). Epidemiology, pathogenesis, and management of takotsubo syndrome. Clinical Autonomic Research: Official Journal of the Clinical Autonomic Research Society, 28(1), 53–65. doi:10.1007/s10286-017-0465-z. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28917022/
Dr. Mike is a licensed physician and the Director, Medical Content & Education at Ro.