How can you mend a broken heart?
How can you stop the rain from falling down?
How can you stop the sun from shining?
What makes the world go round?
- The Bee Gees
We all know that a broken heart is a big deal. Most of us have suffered them at one time or another and know how painful they can be. But can a person die from a broken heart? Actually, yes. When they do, it’s sometimes referred to as Broken Heart Syndrome. And get this. Approximately 90% of people affected are post-menopausal women between the ages of 58 and 77.
Is Broken Heart Syndrome Real?
The phenomenon is real. The medical term is stress cardiomyopathy or takotsubo cardiomyopathy. It was first described by Japanese researchers in 1990 and was nicknamed “Broken Heart Syndrome” when it became clear that emotional stress was the trigger in many cases. No matter what you call it, this is a type of heart attack, but it isn’t caused by a blocked artery. It’s caused by sudden, acute stress.
When we experience stress, our body helps us cope by releasing stress hormones like adrenaline. When we experience extreme stress, our heart can become overwhelmed by these hormones, leading to a rapid weakening of the heart muscle. It can also result in a disruption of the heart’s rhythm, temporary enlargement of the lower part of the left ventricle, and more forceful contractions in other areas of the heart.
The type of stress that induces Broken Heart Syndrome can be emotional or physical. Examples of emotional stress include:
- Extreme Anger
- Surprise (good or bad)
- Bad news
Physical stressors can also be a catalyst. Here are some examples:
- Severe pain
- An exhausting physical event
- High fever
- Difficulty breathing (asthma attack or emphysema)
- Significant bleeding
- Low blood sugar
Make no mistake, Broken Heart Syndrome can be life threatening. Like I said, it’s a type of heart attack. But because blocked arteries are not the culprit, it’s easier to recover from this type of cardiac event – and they are more survivable. Death results in about 1% of cases, so it’s a highly unlikely outcome. However, Broken Heart Syndrome can cause severe heart muscle weakness which can result in congestive heart failure, low blood pressure, shock, and/or potentially life-threatening heart rhythm abnormalities. So, it’s vital to seek treatment without delay if you experience symptoms.
There’s good news. With proper care, this condition can improve quickly and even critical patients tend to recover.
Symptoms that alert you to Broken Heart Syndrome are the same symptoms people experience when they have heart attacks caused by blocked arteries. Symptoms can begin within minutes or it can be hours after an emotionally or physically stressful event.
Here are some of the symptoms associated with heart attack and Broken Heart Syndrome:
- Sudden, severe chest pain
- Shortness of breath
- Irregular heart beats
- Low blood pressure
- Weakening of the left ventricle of the heart
- Fluid in the lungs
What Causes Broken Heart Syndrome
Stress cardiomyopathy did not become widely recognized until 2005, so it’s not surprising that more research is needed. As of now, the cause is not totally clear or fully understood. Still, experts believe there may be a link between Broken Heart Syndrome and estrogen - or the lack of it, to be more precise. Estrogen protects the heart from the damaging effects of adrenaline, but it diminishes in the body as women age. So, it stands to reason that post-menopausal women would be disproportionately affected. According to another hypothesis (that's yet to be proven), stress hormones cause the heart's blood vessels to spasm thereby restricting blood flow to the heart.
Who’s At Risk?
Broken Heart Syndrome can happen to anyone, but your risk of developing it increases 5 times if you’re a woman over age 55. In fact, postmenopausal women make up 90% of cases. Unfortunately, doctors are more likely to diagnose women with a psychosomatic reaction to anxiety when they present with shortness of breath and chest pains.
History of depression, anxiety or neurologic illness can also be risk factors, so stress management is at the top of the list for mitigating risk when it comes to Broken Heart Syndrome.
"For me to suggest a woman's untreated anxiety or depression needs to be managed could sound like I think it's all in their head. How I couch it is, there's a very strong mind-heart connection. If we don't deal with our stress and worry, we can't heal our hearts."
– Sharonne N. Hayes, M.D., cardiologist & founder of the Women's Heart Clinic in Rochester, MN
Approximately 2% of people with suspected heart attacks are actually suffering from Broken Heart Syndrome. However, this statistic is thought to be understated, because the condition is not fully understood and often undiagnosed.
Broken Heart Syndrome is diagnosed with the same tests you would expect when a heart attack is suspected. Physical exam, blood work, EKG, angiogram, echocardiogram, chest x-ray, cardiac MRI and ventriculograms are all tests that doctor’s use to find out what’s going on with the heart. Patients with Broken Heart Syndrome will have an abnormal EKG and increased cardiac enzyme levels in the blood - just like a blockage-induced heart attack (which can only be ruled out with a cardio angiogram).
Medications to slow heart rate and decrease fluid build up are often prescribed on a short-term basis while ace inhibitors to lower blood pressure and anti-anxiety medications to manage stress can be prescribed long term. Regular exercise and avoiding stressful situations is also recommended in addition to an overall healthy lifestyle including nutritious food and adequate sleep.
Of course, ongoing stress management is crucial and may include biofeedback, mindfulness meditation, movement (dancing, t’ai chi, yoga, walking), and social interaction. Seeing a mental health expert can be a good way to learn about managing stress. Seeking help from a professional is also a good idea when stress is overwhelming and unmanageable.Living With It
Outcomes over the long term depends on the stress that caused the condition in the first place. The five-year prognosis is good when the trigger is emotional, according to Johns Hopkins Medicine. It can be more complicated when the stressor is physical, like stroke, asthma or seizures.
The vast majority of people who suffer from Broken Heart Syndrome do not have a recurrent episode, suffer no permanent heart damage, and go on to live normal lives. That’s the way it goes about 95% of the time.
Broken heart syndrome is serious and potentially life-threatening. It’s caused by emotional or physical stress that we may or may not see coming. If you experience symptoms, it’s important to resist the temptation to self-diagnose or minimize warning signals and delay treatment. Always seek medical care, if you have symptoms of a heart attack.
Instyle, “Broken Heart Syndrome” is Surging Among Women – And It’s Way More Serious Than It Sounds, Ashley Abramson, February 10, 2022
Johns Hopkins Medicine, Broken Heart Syndrome, Ilan Shor Wittstein, M.D., No Date
American Heart Association, Broken Heart Syndrome Is On The Rise, Especially Among Older Women, Thor Christensen, American Heart Association News, October 13, 2021
Cleveland Clinic, Broken Heart Syndrome, Cleveland Clinic Medical Professional reviewed, February 10, 2021
THINK, Can you die of a broken heart? Science proves ‘broken heart syndrome’ is real., Jordan Rosenfeld, February 14, 2018