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When a Broken Heart Is Actually Broken

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Not just a figure of speech

Generally speaking, when someone experiences a broken heart, we understand that to mean that they are suffering emotional distress, but not experiencing an actual medical condition. In the area of cardiovascular medicine, however, the phrase “broken heart” is no longer strictly symbolic. Medical professionals now understand that there is a direct link between severe emotional or physical stress and a serious cardiac condition.

“Broken heart syndrome” is a common name for stress-induced cardiomyopathy, or takotsubo cardiomyopathy, a disease that affects the heart’s muscle tissue. In 1990, Japanese researchers named the condition with a variation of the term tako-tsubo, which is a clay pot used by Japanese fishermen to trap octopi. Because this particular cardiomyopathy causes severe swelling of the left ventricle, the swollen ventricle looks similar to the pot. Signs and symptoms of the condition are almost identical to those of a heart attack and may include sudden chest pain, shortness of breath, and an irregular heartbeat.

Researchers have not yet determined a specific cause of broken heart syndrome, but it is known that stress is the trigger for a series of symptoms. The current data strongly suggest that it happens when stress hormones, such as adrenaline, surge into the heart, triggering changes in muscle cells and blood vessels. Those changes prevent the left ventricle from properly contracting. As cardiomyopathy worsens, the weakened heart becomes less able to pump blood or maintain a normal electrical rhythm. The result can be heart failure or irregular heartbeats, known as arrhythmias. A weakened heart also can cause other complications, such as heart valve problems.

Diagnosing broken heart syndrome can be a challenge, notes Gregory Chapman, MD, a UAB Medicine cardiologist who has written A Strong and Steady Pulse: Cardiac Stories (to be published in 2021). The book details his experience in treating, and teaching medical students about, various heart conditions.

“Takotsubo looks for all the world like a heart attack,” Chapman says. “It presents all the typical symptoms, and you could argue that, in a way, it is a kind of heart attack. The only way to know that it’s not a typical one is through examination and tests in a catheter lab, where we can determine by angiogram (a test that uses dye and special X-rays to show coronary arteries) if the arteries are blocked. Once we see that the arteries are normal, but the left ventricle has severely ballooned out, we may diagnose stress-induced, or takotsubo, cardiomyopathy.”

Triggers and treatment

As for what triggers takotsubo, Chapman says that chronic stress over time can create serious health problems, and with extreme cases of cardiac conditions, sometimes “our emotions can kill us.” Among emotion stressors that may induce cardiomyopathy are: the sudden loss of a loved one, being fired from a job, an automobile accident, sudden extreme illness, domestic violence, or experiencing immediate danger, loss, and/or injuries from a natural disaster such as a tornado or hurricane.

Chapman once suspected that a female patient who visited the ER for chest pains was experiencing the syndrome, primarily because the woman had just learned that her daughter had been killed in a plane crash. An examination in the catheter lab confirmed that the patient had no blocked arteries, and an x-ray view showed her left ventricle had swollen. It was a typical case of stress-induced cardiomyopathy.

Procedures that are often used to treat a heart attack, such as balloon angioplasty and stent placement, or even surgery, are not effective treatments for broken heart syndrome. Standard treatment mainly involves the use of medications that manage the symptoms and effects of the cardiomyopathy. Initial recovery takes place with a hospital stay. Afterwards, for about a 90-day period patients will take the same medications used to treat congestive heart failure to support and strengthen the heart. Most patients recover within 30 to 90 days.

People who have broken heart syndrome usually don't have any heart disease symptoms before they're diagnosed with the syndrome. More than 90 percent of reported cases are in women ages 58 to 75. Research suggests that up to 5 percent of women evaluated for a heart attack actually have this disorder, which can go unrecognized.

Stress-induced cardiomyopathy is seldom fatal, but causes heart failure in about 20 percent of patients. Rarely reported complications include arrhythmias (abnormal heart rhythms), obstruction of blood flow from the left ventricle, and rupture of the ventricle wall. Fortunately, most affected people quickly recover with no permanent damage to the heart muscle.