We learn about broken hearts at a very young age. Children’s books and cartoons show the heart shape broken into two pieces, usually with a zigzag at the cleft.
Most people relate a broken heart to a failed relationship. But we are treating more patients for physical conditions related to what’s known as broken heart syndrome. According to a 2018 study, the condition affects 15 to 30 people per 100,000 a year.
While it’s mysterious, broken heart syndrome is indeed real. It affects mostly postmenopausal women, usually in their 70s or older, but a small number of patients are younger. Many times it happens after the patient has experienced a stressful event.
Also known as takotsubo cardiomyopathy, broken heart syndrome was first described in 1990 in Japan. It is a sudden weakening of the left ventricle of the heart, the chamber that pumps blood to all parts of the body.
Patients with broken heart syndrome may experience chest pain or tightness. Some also may experience shortness of breath. Many patients believe they are having a heart attack, but when we do our examination, we find no blockages in the heart vessels. Many of these people develop weakness of the heart and electrocardiographic changes that normalize over time.
Causes of broken heart syndrome
The exact cause of broken heart syndrome is not fully understood, but many doctors believe it can be triggered by mental or physical stress. It can be a traumatic event, such as the death of a spouse, or something that causes the patient to worry, such as an upcoming surgery.
According to the 2018 study, risk factors can include anxiety/depression, diabetes, substance abuse disorders, and asthma/chronic obstructive pulmonary disease (COPD). Because it primarily affects older women, some have hypothesized that the condition may be linked to estrogen levels.
Diagnosing broken heart syndrome
Common diagnostic tests to rule out a heart attack and confirm broken heart syndrome include:
Cardiac enzyme studies: To show if heart muscle was destroyed
Electrocardiogram (ECG or EKG): To look for time elevations or depressions at the end of the ventricles’ contractions (lower heart chambers) and evaluate the time of the recovery period
Coronary angiogram: To check if there’s a restriction or blockage in blood flow, using X-ray imaging to view the heart's blood vessels
Physical exam: To check for low blood pressure, high heart rate, or a new mitral regurgitation murmur
In recent years, a small number of patients with COVID-19 have developed takotsubo cardiomyopathy syndrome, as have some who experienced emotional stress during the pandemic. One study linked a woman’s condition to an adverse reaction to COVID-19 vaccine.
I was an intern the first time I witnessed broken heart syndrome. The patient was elderly and sick. Her daughter told us to be very careful and asked us to spend extra time with her. She was worried that any other kind of approach could “scare her to death.” Another time, a patient had arthritis and was soon going to have a hip replaced. The looming procedure caused her a lot of worry, which we believe caused the issue with her left ventricle.
Broken heart syndrome is not considered a rare condition. While its exact frequency is unknown, most studies suggest it affects 1% to 2% of patients who have symptoms similar to a blockage of the blood supply to the heart. Those symptoms include chest pain, tightness, and/or shortness of breath.
Treatment and recovery
Fortunately, very few people die from broken heart syndrome. It’s often a scary situation for the patient and her or his family, but many patients recover without any lasting damage.
It’s vital that we discuss any history of stress cardiomyopathy with patients who present with these symptoms. Cardiac imaging including ultrasound, CT imaging, and cardiac MRI may be performed in patients with stress cardiomyopathy to assess the coronary arteries and/or heart function.
We prescribe the same kinds of medications for broken heart syndrome as we would for a patient who has had a heart attack: beta-blockers and ace inhibitors. In addition, we help patients work through situations that are causing them stress.
We’ve found that this combination of removing the stressor and prescribing medication often helps the patient’s heart function return to normal.
To schedule an appointment with a UT Southwestern heart specialist, call 469-884-7442 or request an appointment online.
