Scientists are learning more about a newly defined heart condition that mimics severe heart attacks and can strike healthy people.
Broken heart syndrome, or takotsubo cardiomyopathy, is most often triggered by physical or emotional distress, such as the loss of a loved one, severe illness or a major life event. It can strike even healthy people, unlike a heart attack, which most often occurs in people with underlying health conditions.
A team at New York University Langone Health is about to launch a clinical study into takotsubo syndrome to explore the efficacy of deep breathing as therapy for people with a past history of broken heart syndrome.
The goal is to see whether breathing exercises can aid the parasympathetic nervous system and prevent another attack.
Broken heart syndrome can develop at any age, but it tends to affect more women than men 58 to 75. Signs feel like a heart attack, causing crushing chest pain, shortness of breath, a rapid or irregular heartbeat, dizziness, fainting and sweating.
Although broken heart syndrome isn’t classified as rare, its true prevalence remains unclear. However, most research estimates that it accounts for one percent to two percent of patients presenting with heart attack-like symptoms.
Few people die from broken heart syndrome. Unlike a heart attack, which kills 12 percent to 15 percent of patients and involves a block in blood flow to the heart, broken heart syndrome is a temporary weakening of the heart muscle, often triggered by a surge of stress hormones.
This key difference means that while the initial symptoms are just as alarming, the condition does not cause permanent damage and the vast majority of patients see their heart function return to normal within a few weeks to two months.
Broken heart syndrome can occur at any age but is most common in women ages 58 to 75. Symptoms mimic a heart attack and include crushing chest pain, shortness of breath, irregular heartbeat, dizziness, fainting and sweating (stock image)
Exactly how intense stress causes the heart to suddenly weaken isn’t fully understood but researchers believe it starts with a massive surge of hormones like adrenaline.
One leading theory is that this flood of chemicals temporarily renders the heart’s muscle cells toxic, essentially stunning them.
Another idea is that adrenaline makes the heart’s lower chamber contract so forcefully that it effectively shuts down as a protective measure.
A related theory suggests that the heart is simply trying to conserve energy by dialing back its pumping power in response to overload.
There’s also evidence that extreme stress can cause the heart’s smallest blood vessels to constrict, briefly limiting blood flow in a way that mimics a heart attack without any actual blockages.
While the exact mechanism is still being studied, all theories point to an overwhelming physical or emotional event that can, for a short time, disrupt the heart’s ability to pump properly.
Diagnosing broken heart syndrome is a process of elimination.
Because its symptoms, including chest pain, shortness of breath and an abnormal echocardiogram (EKG), are identical to a heart attack, doctors first assume the worst.
An EKG uses sound waves to capture a live image of the heart and determine whether the lower chamber has a distinctive shape. In broken heart syndrome, the heart’s main pumping chamber balloons out at the bottom while the neck remains narrow.
These images capture the telltale shape of broken heart syndrome. Panel B shows the heart’s main pumping chamber relaxed and filled with blood (diastole). In Panel C, the heart contracts (systole), revealing the classic ‘takotsubo’ shape – the bottom balloons out while the base narrows, resembling the Japanese octopus pot that gives the condition its medical name
A blood test also checks for elevated levels of a protein called troponin, which leaks into the bloodstream when the heart muscle is damaged. But the only way to definitively rule out a heart attack involves a procedure called cardiac catheterization.
A thin tube is threaded into an artery and fed to the heart, where dye is injected to create a detailed X-ray of the coronary arteries.
If they are clear of blockages, doctors can confidently say that the patient is not having a heart attack and instead is likely experiencing takotsubo cardiomyopathy.
Patients are often active people with no prior history of heart problems. They usually exercise, eat well and have low cholesterol and normal blood pressure. They may have also recently passed a series of medical health checks with flying colors.
This is because broken heart syndrome is not caused by clogged arteries or long-term neglect of one’s health.
The leading causes of broken heart syndrome include financial stress, domestic violence, death of a relative or friend, serious illness or surgery, intense fear and receiving bad news.
Dr Harmony Reynolds, a cardiologist at NYU Langone Health, told the New York Post: ‘One common misconception is that broken heart syndrome is always caused by severe emotional trauma. In reality, triggers can be subtle, cumulative or even positive. Joyful or exciting events can also place significant stress on the body.
‘Stress responses are deeply ingrained biological processes — not personal failings — and no one should blame themselves for developing a physical condition triggered by stress.’
She added that broken heart syndrome can be caused by cumulative stress, not just a single dramatic moment.
Because people who are stricken with broken heart syndrome are generally healthy, recovery usually takes about two months to fully recover. A heart attack may take slightly more time to recover from and inflict permanent damage through extensive scarring.
Treatment for broken heart syndrome is not standardized. It varies depending on the severity of a person’s symptoms, blood pressure stability and whether fluid is backing up into the lungs.
Most patients are started on standard heart failure medications such as beta blockers, ACE inhibitors and diuretics.
While long-term data is sparse, beta blockers are often continued indefinitely to help prevent recurrence by blunting the effects of adrenaline. Managing emotional and physical stress is also a key part of recovery and prevention.
