Broken heart syndrome

Overview

Broken heart syndrome is a heart condition that's often brought on by stressful situations and extreme emotions. The condition also can be triggered by a serious physical illness or surgery. Broken heart syndrome is usually temporary. But some people may continue to feel unwell after the heart is healed.

People with broken heart syndrome may have sudden chest pain or think they're having a heart attack. Broken heart syndrome affects just part of the heart. It briefly interrupts the way the heart pumps blood. The rest of the heart continues to work as usual. Sometimes the heart contracts more forcefully.

Medicines are used to treat symptoms of broken heart syndrome.

Broken heart syndrome also may be called:

• Stress cardiomyopathy.
• Takotsubo cardiomyopathy.
• Recurrent takotsubo cardiomyopathy.
• Apical ballooning syndrome.

Symptoms

Symptoms of broken heart syndrome can mimic those of a heart attack. Symptoms may include:

• Chest pain.
• Shortness of breath.

When to see a doctor

Any continued chest pain could be due to a heart attack. Call 911 or your local emergency number if you have new or unexplained chest pain. Also call if you have a very rapid or irregular heartbeat or shortness of breath.

Causes

The exact cause of broken heart syndrome is unclear. It's thought that a surge of stress hormones, such as adrenaline, might damage the hearts of some people for a short time. How these hormones might hurt the heart or whether something else is the cause isn't completely clear.

A temporary squeezing of the large or small arteries of the heart may play a role in the development of broken heart syndrome. People who have broken heart syndrome also may have a change in the structure of the heart muscle.

An intense physical or emotional event often comes before broken heart syndrome. Anything that causes a strong emotional reaction may trigger the condition. Examples include:

• Sudden illness such as an asthma attack or COVID-19.
• Major surgery.
• Sudden broken bone.
• Death of a loved one or other loss.
• Strong argument.

Rarely, use of certain medicines or illegal drugs may lead to broken heart syndrome. They include:

• Emergency medicines used to treat severe allergic reactions or severe asthma attacks.
• Some medicines used to treat anxiety.
• Medicines used to treat a stuffy nose.
• Illegal stimulant drugs, such as methamphetamine and cocaine.

Always tell your healthcare team about the medicines you take, including those bought without a prescription. When starting a new medicine, talk to your care team about the potential risks and side effects.

How is broken heart syndrome different from a heart attack?

Heart attack is generally caused by a complete or near-complete blockage of a heart artery. In broken heart syndrome, the heart arteries are not blocked. But blood flow in the arteries of the heart may be reduced.

Risk factors

Risk factors for broken heart syndrome include:

• Sex. Broken heart syndrome is more common in women than in men.
• Age. Most people who have broken heart syndrome are older than 50.
• Mental health conditions. People who have had or have anxiety or depression may have a higher risk of broken heart syndrome.

Complications

Most people who have broken heart syndrome quickly recover and usually don't have long-lasting effects. But sometimes the condition comes back. This is called recurrent takotsubo cardiomyopathy.

Rarely, broken heart syndrome can cause death.

Complications of broken heart syndrome include:

• Backup of fluid into the lungs, called pulmonary edema.
• Low blood pressure.
• Irregular heartbeats, called arrhythmias.
• Heart failure.
• Blood clots in the heart.

Prevention

To prevent another episode of broken heart syndrome, many healthcare professionals recommend long-term treatment with beta blockers or similar medicines. These medicines block the potentially harmful effects of stress hormones on the heart.

Having chronic stress may increase the risk of broken heart syndrome. Taking steps to manage emotional stress can improve heart health and may help prevent broken heart syndrome. Some ways to reduce and manage stress include:

• Get more exercise.
• Practice mindfulness.
• Connect with others in support groups.

Diagnosis

Broken heart syndrome is often diagnosed in an emergency or hospital setting because symptoms mimic those of a heart attack.

To diagnose broken heart syndrome, a healthcare professional examines you and asks questions about your symptoms and medical history. You may be asked if you've had any major stresses recently, such as the death of a loved one.

People who have broken heart syndrome usually don't have any heart disease symptoms before the condition is diagnosed.

Tests to help diagnose broken heart syndrome include:

• Blood tests. People who have broken heart syndrome often have higher levels of substances called cardiac enzymes in the blood.

• Electrocardiogram (ECG or EKG). This quick test measures the electrical activity of the heart. Sticky patches called electrodes are placed on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which shows the test results.

  An ECG shows how fast or how slow the heart is beating. ECG results for broken heart syndrome look different from those for a heart attack.

• Coronary angiogram. This test checks for blockages in the heart arteries. It's done to rule out a heart attack. People with broken heart syndrome often don't have any blockages. A doctor inserts a long, thin flexible tube called a catheter into a blood vessel, usually in the groin or wrist. It's guided to the heart. Dye flows through the catheter to arteries in the heart. The dye helps the arteries show up more clearly on X-ray images and video.

  Once it's clear that you're not having a heart attack, your doctor checks to see if your symptoms are caused by broken heart syndrome.

• Echocardiogram. This test uses sound waves to create pictures of the beating heart. It shows how blood flows through the heart and heart valves. It can see if the heart is enlarged or has an unusual shape. These changes may be due to broken heart syndrome.
• Cardiac MRI. This test uses magnetic fields and radio waves to create detailed images of the heart.

Treatment

There's no standard treatment for broken heart syndrome. Treatment is similar to heart attack care until the diagnosis is clear. Most people stay in the hospital while they get better.

Many people with broken heart syndrome are fully recovered within a month or so. An echocardiogram is done about 4 to 6 weeks after the first symptoms to make sure the heart is working better. Sometimes, broken heart syndrome happens again after treatment.

Medications

Once it's clear that broken heart syndrome is the cause of the symptoms, medicines may be given to reduce the strain on the heart. Medicines also can help prevent further episodes of broken heart syndrome.

Medicines may include:

• Angiotensin-converting enzyme inhibitors, also called ACE inhibitors.
• Angiotensin 2 receptor blockers, also called ARBs.
• Beta blockers.
• Water pills, also called diuretics.
• Blood thinners, if there is a blood clot.

Surgeries or other procedures

Surgeries and procedures that are often used to treat a heart attack aren't helpful in treating broken heart syndrome. Such treatments open blocked arteries. Blocked arteries do not cause broken heart syndrome.

Preparing for an appointment

Broken heart syndrome is usually diagnosed in an emergency or a hospital setting.

If possible, have a family member or friend come with you to the hospital. Someone who goes with you can help you remember the information you're given.

If possible, share important information with the person taking you to the hospital:

• Any symptoms you're having, and how long you've had them.
• Your important personal information, including any major stresses, such as the death of a loved one, or recent life changes, such as the loss of a job.
• Your personal and family medical history, including health conditions such as diabetes, high cholesterol or heart disease.
• A list of the medicines you take, including those bought without a prescription.
• Any recent injury to your chest that may have caused damage inside the body, such as a broken rib or pinched nerve.

At the hospital, you may have many questions. If possible, you may want to ask:

• What do you think is causing my symptoms?
• I recently experienced the sudden death of a loved one. Could my symptoms be due to this event?
• What kinds of tests do I need?
• Do I need to stay in the hospital?
• What treatments do I need right now?
• What are the risks associated with these treatments?
• Will this happen again?
• Do I have any diet or activity restrictions?

Don't hesitate to ask any additional questions.

What to expect from the doctor

A healthcare professional who sees you for chest pain may ask:

• What symptoms are you having?
• When did the symptoms begin?
• Does your pain spread to any other parts of your body?
• Does your pain briefly get worse with each heartbeat?
• What words would you use to describe your pain?
• Does exercise or physical activity make your symptoms worse?
• Do you have a family history of heart problems?
• Are you being treated or have you recently been treated for any other health conditions?