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.
