What is broken heart syndrome?

John Erwin, MD

Cardiology

Most of us think of a “broken heart” in the emotional sense: the end of a relationship, a major loss or a painful disappointment. Broken heart syndrome, on the other hand, refers to a very real physical condition also known as Takotsubo cardiomyopathy. And yes, moments of significant emotional pain or stress can cause it.

Cardiologist John Erwin, MD, has seen how serious broken heart syndrome can be. He answered our common questions on heart attacks caused by broken heart syndrome and more.

What is broken heart syndrome?

“Broken heart syndrome is a temporary weakening of the heart muscle, and it often looks and feels like a heart attack,” said Dr. Erwin. “Patients arrive with crushing chest pain, shortness of breath and EKG changes that trigger the same alarms we see during a true heart attack.”

In a heart attack, blood flow is blocked by a clogged artery. When you have broken heart syndrome, however, the cause isn’t a blockage. Instead, cardiologists believe the heart is hit with a surge of stress hormones like adrenaline that essentially stun it.

This rush of stress hormones tends to happen as a result of intense grief, physical pain or stress, with causes including:

• The death of a loved one
• A breakup or family conflict
• A frightening medical diagnosis
• A natural disaster or accident

“Surprisingly, it can also occur after positive stress, such as an unexpected celebration or emotional surprise,” added Dr. Erwin. “The common thread is the abrupt spike in adrenaline.”

What does broken heart syndrome feel like?

When you’re experiencing broken heart syndrome, it will feel essentially exactly the same as a heart attack, with the same group of common symptoms, including:

• Sudden chest pain or pressure
• Shortness of breath
• Nausea
• Heavy sweating, especially with activity
• Loss of consciousness or even cardiac arrest

“As a physician who has cared for thousands of heart patients, I cannot stress enough that you should seek emergency medical attention immediately if you have these symptoms,” said Dr. Erwin. “Do not wait! Receiving medical attention as quickly as possible is your best chance at getting treatment in time. Your heart is too important to risk.”

How is broken heart syndrome diagnosed?

The initial evaluation is treated the same as for a heart attack. Your doctor will perform a careful physical exam, run blood tests to check for signs of heart damage and perform an EKG. Most people will also need to undergo other imaging, such as an echocardiogram to check on the blood vessels that supply the heart with blood.

This helps your medical team to make sure that blood flow in the arteries hasn’t been blocked or impacted and to check on how the heart muscle is working.

Are you at risk for broken heart syndrome?

“Anyone can experience broken heart syndrome,” said Dr. Erwin. “However, it’s most common in post-menopausal women, with up to 90% of cases occurring in women. The reasons for this are still being studied, but hormonal changes and differences in how the body responds to stress appear to play a role.”

Dr. Erwin noted that about 1-2% of those who seek medical care for heart attack symptoms end up being diagnosed with broken heart syndrome.

Can you prevent broken heart syndrome?

“Unfortunately, we can’t predict or prevent the triggering event,” said Dr. Erwin. “Life brings emotional highs and lows, and sometimes the heart responds in unexpected ways.”

What you can do is take steps to lead a heart-healthy lifestyle and build resilience to emotional and physical stress. Prioritize getting enough sleep, leading an active lifestyle with enough exercise and seek out emotional and social support especially during emotionally overwhelming or painful times. For many, speaking with a doctor about lifestyle medicine can be very helpful in learning how to build those heart-healthy habits.

How is broken heart syndrome treated?

“Once we diagnose the condition, we typically start medications to help your heart to heal,” said Dr. Erwin. “These medications are similar to the medicines used for heart failure. We can support the heart’s function while it returns to normal.”

Most patients recover within 3–6 months, with periodic check-ins to be sure the heart remains healthy.

“Broken heart syndrome is a powerful reminder that our emotional and physical health are deeply connected,” said Dr. Erwin. “I’ve spent decades caring for the heart in all of its complexity, and I want every patient and family to know that you should never, ever wait to seek care if you feel signs of a possible heart attack. You only get one heart, and it deserves your attention, compassion and care.”