What is Broken Heart Syndrome?

Many people are aware of the phrase “broken heart” and associate it with sadness. The more medically minded might also think of broken heart syndrome, a rare but real heart condition that most often occurs following a particularly stressful or emotional event — hence the name. Experts refer to broken heart syndrome with a myriad of different names including takotsubo cardiomyopathy, apical ballooning syndrome, and stress cardiomyopathy. Physicians don’t fully understand the syndrome or its intrinsic causes. The condition is usually temporary, with symptoms lasting a few days to a few weeks.

Symptoms

The distinguishing symptom of broken heart syndrome is a weakening of the left ventricle. The most common results of this are chest pain and shortness of breath. Some people with broken heart syndrome have irregular heartbeats, and sometimes the heart becomes too weak to pump blood properly, due to cardiogenic shock. This can result in loss of consciousness or even death. Each of these symptoms can appear during or following a heart attack, making it difficult to distinguish between the two.

Heart Break vs. Heart Attack

Despite their similarities, there are key differences between broken heart syndrome and a heart attack. Primarily, broken heart syndrome typically only occurs following an extremely emotional event or when a person is under large amounts of stress. Electrocardiograms show different results for heart attacks and broken heart syndrome. Blood tests show no signs of heart damage in the case of broken heart syndrome. Additionally, broken heart syndrome has a unique physical effect that heart attacks do not.

Physical Effect

Two of the alternative names for broken heart syndrome stem from this unique physical effect. X-rays of the left ventricle of the heart show apical ballooning, which occurs when the heart contracts, causing the midsection and the tip of the left ventricle to expand outward. The base contracts normally. The resulting shape is similar to a takotsubo, a round, narrow-necked Japanese vessel for catching octopuses, hence the alternative term, takotsubo cardiomyopathy.

Hormonal Causes

Though doctors don’t fully understand the causes of broken heart syndrome, they do have a few suspicions. Because the condition follows emotional and stressful events, some doctors believe that stress hormones play a role. The body releases a surge of these, such as adrenaline, in response to certain stimuli. The prevailing theory is that these hormones somehow damage the heart or force it to function abnormally. Unfortunately, how these hormones hurt the heart remains unclear. A few physicians suggest a temporary constriction of the heart’s arteries may also be to blame for broken heart syndrome.

Triggers

Normally, broken heart syndrome follows an intense trigger. Events that can lead to broken heart syndrome include:

The death of a loved one

The loss of a job

Domestic abuse

Frightening medical diagnoses

Divorce

The loss or gain of large amounts of money

Public performances

Physical stressors such as surgeries, car accidents, injuries, and asthma attacks also seem capable of causing broken heart syndrome. Because of this, it may be more accurate to refer to the condition as apical ballooning syndrome or takotsubo syndrome, as the condition results from something other than a “broken heart.”

Medications for Broken Heart Syndrome

Some medical experts suspect drugs or medications can cause broken heart syndrome when they are responsible for an increase in stress hormones. Medications that treat allergic reactions or asthma attacks often contain large amounts of adrenaline. Certain antidepressants may also cause these symptoms. Occasionally, medications doctors prescribe to people experiencing thyroid issues, which contain hormones that help regulate metabolism, cause broken heart syndrome or similar effects.

Risk Factors

Broken heart syndrome affects women far more often than it affects men. Whether the reasons for this are physical or psychological is unknown. In addition, the condition generally affects people over the age of 50. Those with a history of neurological conditions, head injuries, or seizure disorders are at significantly greater risk, as are those with psychiatric disorders such as anxiety or depression.

Complications

Without treatment, broken heart syndrome can lead to death. However, fatal results are rare, and the condition typically has a much shorter recovery time than other heart-related issues. Because the syndrome can impact the heart’s ability to pump blood, it can lead to dangerous complications including a backup of fluid into the lungs, or pulmonary edema. Low blood pressure and heartbeat disruptions may also occur. In rare instances, a person may experience heart failure.

Diagnosing Broken Heart Syndrome

Once a doctor suspects the syndrome, it is generally simple to diagnose. Because heart attacks and broken heart syndrome share symptoms, however, it is possible for a doctor to confuse the two conditions. Nonetheless, tests would show no evidence of a blockage in the arteries in the case of broken heart syndrome. In addition, doctors may note a small but fast rise of cardiac biomarkers, substances that enter the bloodstream after damage to the heart. Conversely, heart attacks feature a slow but substantial rise. Finally, echocardiograms, ultrasounds that can show images of the heart, can document apical ballooning.

Treatment

Because doctors know so little about the condition, there are currently no evidence-based guidelines for treating broken heart syndrome. Physicians may opt to use medications with a positive history of improving heart health, such as beta blockers, ACE inhibitors, and diuretics. Beta blockers can be used into the recovery period. A key role in its treatment is ensuring that the emotional event that triggered the issue has resolved. If not, the patient may require special counseling to learn stress management techniques to keep their condition from worsening or recurring.