Mending a Broken Heart

The folklore of broken heart syndrome has been around for decades, but the prevalence of the condition remains unknown.  While stress cardiomyopathy is not as common as a heart attack, it likely occurs more frequently than realized. 

Broken heart syndrome is a temporary heart condition in which intense emotional or physical stress causes rapid and severe heart muscle weakness (cardiomyopathy).  This condition was originally called takotsubo cardiomyopathy.  Symptoms of broken heart syndrome mimic a heart attack and can easily be mistaken as that.

However, in contrast to heart attack, broken heart syndrome affects previously healthy people.  According to Eugenia Raichlin, MD, anyone can be subject to broken heart syndrome, but it occurs most frequently in middle-aged and elderly women with few risk factors for heart disease.

“While it can also occur in young women and even in men, the vast majority of the patients we have seen with this are post-menopausal women,” Dr. Raichlin said.  “The exact reason for this is unknown.”

A hallmark feature of broken heart syndrome is the unique contraction pattern of the heart when viewed by echocardiogram.  While the base of the heart’s main pumping chamber contracts normally, there is a weakened contraction in the middle and upper portions of the muscle.  Other characteristics included a distinctive pattern on electrocardiogram (EKG).  While most heart attacks occur due to blood clots formation and blockages of the coronary arteries, in broken heart syndrome coronary angiogram shows no blockages in the arteries supplying the heart.  Dr. Raichlin said blood tests in broken heart syndrome patients do not show signs of a heart attack, such as elevated levels of cardiac enzymes that are released into the blood stream from damaged heart muscle.  Magnetic resonance imaging (MRI) scans excludes irreversible heart muscle damage. 

The most common cause of broken heart syndrome is emotional stress, such as news of a death of a loved one, shock from a surprise party, anxiety, a car accident or any other traumatic experiences.  It can also occur following numerous physical stressors to the body such as stroke, seizure, difficulty breathing (such as a flare of asthma or emphysema), or significant bleeding. 

The catecholamines, molecules that circulate in the bloodstream, may cause a spasm in the coronary arteries, or have a direct toxic effect on the heart muscle, or cause calcium overload that results in temporary stunning of the heart muscle and produces symptoms similar to a heart attack, including chest pain, shortness of breath and heart failure. 

While not as severe as a heart attack, broken heart syndrome can be life threatening in some cases because the syndrome involves severe heart muscle weakness.  Patients could have congestive heart failure, low blood pressure, shock and potentially life-threatening heart rhythm abnormalities. 

However, Dr. Raichlin said most patients suffering from the syndrome make a complete recovery.

“Typically these symptoms begin just minutes to hours after the person has been exposed to a severe, and usually unexpected stress,” she said.  “We treat the acute symptoms such as heart failure or arrhythmia.  No long term treatment is needed.”

Recovery time for patients experiencing broken heart syndrome can be as early as a few days and usually no longer than a couple of weeks.

“The good news is that this condition improves very quickly, so if patients are under the care of physicians familiar with this syndrome, even the most critically ill tend to make a quick and complete recovery,” Dr. Raichlin said.

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