The name “broken heart syndrome” might conjure up images of a romance – an emotional tale of one person who can’t live without another. But broken heart syndrome is a real medical condition, and it doesn’t refer to a figurative broken heart. Its official name is stress cardiomyopathy, and it’s a sudden, rapid weakening of the heart muscle brought on by stress.
Events that cause widespread tension and anxiety can cause societal increases in broken heart syndrome. During the COVID pandemic, doctors at the Cleveland Clinic recorded a more than four-fold rise in broken heart syndrome diagnoses, the Journal of the American Medical Association reports. The current societal upheaval across the country is causing widespread stress that could lead to a similar increase in broken heart syndrome.
Dr. Frederick “Trip” Meine is a cardiologist with Novant Health Heart & Vascular Institute – Wilmington who has treated the condition many times. We talked to him about its symptoms, how it’s diagnosed and why you should always take chest pain seriously.
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What exactly is stress cardiomyopathy, or broken heart syndrome?
It can happen when the heart muscle is overwhelmed by a sudden adrenaline rush brought on by stress. Too much adrenaline can cause the small arteries that supply blood to the heart to constrict, so less blood is reaching the heart.
It has another name, too. Its original name was “takotsubo cardiomyopathy.” After an episode of stress cardiomyopathy, the heart takes on a shape similar to a traditional Japanese octopus trap, called a takotsubo. It has a narrow neck where the octopus crawls in and a bulbous end where it’s trapped.
A Japanese cardiologist was the first to notice and describe the condition in the early ’90s. … It wasn’t widely known in the U.S. until a New England Journal of Medicine article in 2005. Until then, it was thought that only Japanese people, or those with Japanese ancestry, ever experienced stress cardiomyopathy. Back then, we’d have patients review their entire genetic tree to try to find any Japanese heritage. We don't do that now, because we know it can happen to anybody.
Broken heart syndrome sounds scary. People must fear they’re having a heart attack.
Yes. And the way they describe their symptoms is often the same way people having heart attacks describe theirs. The problem is: Until you do some sort of testing, you don’t know. That’s why we always tell people: When you have these symptoms, call 911. Treat it as if it’s a heart attack.
What causes broken heart syndrome?
There are all sorts of theories; nobody knows for sure. The bad news is that it can happen. The good news is it typically resolves over days to weeks and doesn’t come back.
I’ve got a couple of patients who’ve had it happen more than once, but it’s very rare.
We don’t spend a lot of time trying to pinpoint the one very stressful episode that led someone to have stress cardiomyopathy. It's usually obvious – the death of a loved one, a natural disaster, a divorce. But it can be anything that revs up your sympathetic nervous system. (That’s the system that triggers the fight-or-flight response.)
Pinpointing an actual stressor isn’t required for diagnosis. The condition can be brought on by “everyday stress,” which all of us experience. Whenever I ask anybody if they have anything stressful going on their life, I can count on one hand the number of my patients who’ve said nothing is stressing them out at the moment. Everybody has some stressors in their life.
Who is most susceptible to broken heart syndrome?
It happens to women more often than men. (Editor’s note: Women made up 88.3% of U.S. cases of broken heart syndrome between 2006 and 2017, the American Heart Association reports.) And usually, it happens to post-menopausal women. The patient can usually figure out what the stressor is. It may be a house fire, death in the family, the dog got hit by car.
A few years ago, a woman whose husband had come to the hospital with chest pain was told her husband was having a heart attack. Once she heard the news, she began experiencing chest pain herself. We put husband and wife in side-by-side rooms in the cath lab. He was having a heart attack; she was experiencing takotsubo.
When someone comes to the ER with chest pain, what can they expect?
Our ER staff is very good at triaging people with chest pain and looking for the really serious things first. People get treated very urgently – as if they are having a heart attack. They get the appropriate tests, including an EKG and labs. And if it looks like it could be a heart attack, then they get cardiologists involved.
Is broken heart syndrome hard to diagnose?
Yes, but only because there’s no lab test, EKG or other noninvasive procedure that can definitively diagnose it. Typically, it requires a heart catheterization to show that characteristic shape of the heart and that there's not something else causing that. It's not hard to diagnose, but it does involve an invasive procedure.
Because symptoms – chest pain, shortness of breath, nausea, dizziness – mimic those of a heart attack, it’s treated at the hospital as if the patient is having a heart attack. The difference is: Patients who’ve had heart attacks have blocked arteries. People with cardiac myopathy don't.
Describe a heart catheterization.
While the patient is under moderate sedation, we insert a catheter – a thin, flexible tube – into a blood vessel in the groin, arm or neck and guided to the heart. It’s used to diagnose and treat some heart conditions.
Once you've determined that it’s broken heart syndrome, what’s next?
The condition will have decreased someone’s heart function. We treat the heart function with medicine – beta blockers, ACE inhibitors – and support them (with supplemental oxygen, for instance) until their function recovers. How long a patient is on medicine depends on their progress, but typically we see recovery of heart function in days to weeks. To be safe, they should continue to see a cardiologist long term.Reducing stress for heart health: When life events become overwhelming, try these strategies to cope
We’ve all experienced moments that leave us flattened. It might be a frightening diagnosis for us or a loved one. A job loss. A divorce or other personal crisis. Unrelenting fears about climate change or the state of the country.
Making it through the day can be a challenge, let alone knowing how to face a future that might not be what you expected.
Feeling stress is a natural response to your environment, according to Sheena Baker, licensed clinical social worker and social work intern program supervisor with Novant Health’s Office of Health Equity and Community Health.
The nervous system receives stressful information through sight, sound and other senses. When we get stressed, “it starts to affect our sleep, our mood, and our motivation,” Baker said. She offers these coping tools to help lift anyone facing stressful times.
Focus on what’s in your control. Look at how your behaviors might contribute to your stress. One example: Set boundaries between your work and personal life. If possible, don’t answer work-related emails after work so you can focus on family and other interests. Resist the urge to just take a peek for "piece of mind." Or start by doing it less then build on the habit.
Take breaks from social media and 24/7 news. Baker signs off from social media for several weeks at a time to avoid clickbait and algorithms that highlight the most alarming posts first. If you’re a news junkie, at least turn off your news alerts. You can check sites a few times a day. Stepping back from the firehose can make a big difference.
Regarding the news, she suggests reviewing which news sources you consume and when. Maybe your lunch break is a better time than right out of bed to help set a calmer tone for the day.
Connect with people in real life. “Spending time with people in-person releases our happy hormone, dopamine,” Baker explained. “When you hang out with friends, family, neighbors, church members, or social groups, you feel included and safe. Safety is the opposite of stress and angst.”
Baker recommends Meetup as a way to find others who share your interests. Introverts might try game nights at a local brewery or restaurant. “You can focus on the game without having to be so focused on the people, but you're still getting that interaction,” Baker said.
Even waving at a neighbor or giving someone a compliment at the coffee shop works. Spending time with pets also releases dopamine and reduces anxiety.
Find hobbies you enjoy. Pick one that takes a lot of time, like learning to play an instrument, or a little, like listening to music after work. Either way, hobbies help calm the nervous system by focusing the brain on something fulfilling and enjoyable rather than on stress-provoking circumstances that typically resolve themselves. The point is not to be the best or even good at something. It’s the effort that can make a difference.
Exercise. “We experience stress physically. If we stay active, that helps release stress hormones like cortisol,” Baker explained. Go to the gym or try free alternatives like dancing, walking, yoga videos online, or playing with your children in ways that require movement. Build in exercise during the day, such as parking farther from the store entrance to get more steps.
Care for yourself with nutritious foods. It’s natural to reach for donuts or potato chips in times of stress. But poor nutrition can lead to irritability, anxiety and difficulty concentrating, leaving you unable to think through stressful situations, Baker said. Emphasize nutrient-rich foods in your meals, including salmon, beans, nuts and seeds, citrus fruits and leafy greens to help your brain and body function well. Go easy on caffeine and alcohol.
Harness tech that supports mental health. Novant Health patients can take advantage of the NeuroFlow app, with guided imagery videos, journaling, breathing exercises and articles for mental health. Talk to your primary care provider about this option.
Try Calm or Headspace apps for meditation. Baker likes Daylio, which allows you to track activities that affect your mood. “You can start to determine what you want to do more of in your life that helps you feel better,” she said, “and what you want to decrease.”
If possible, take action to address your fears. It’s easy to linger on worries about the future when something devastating happens. Consider where you can take action, from having a thoughtful conversation with your spouse to attending a public meeting about a proposed government policy. “If we find ways to take action,” Baker said, “that usually gives us a sense of feeling better because we've thought about what options we might have.”
