Is it real?

When we lose someone that we care about, we’re usually deeply saddened and grieve. For individuals who lose someone, like their spouse, this can be especially traumatic. In some cases, these individuals end up passing away not too long after as well. Some refer to this phenomenon as Broken Heart Syndrome. How much truth is in the concept? Are there things you can do to help someone who may be experiencing it?

Broken Heart SyndromeBroken heart syndrome is a temporary heart condition that occurs when the lower part of the left ventricle (apex) temporarily enlarges, resulting in it not pumping well. The rest of your heart functions normally or might even have more forceful contractions. During contraction (systole), the bulging ventricle resembles a tako-tsubo, a pot used by Japanese fishermen to trap octopuses, which is why it’s also called takotsubo cardiomyopathy. Another term for the disorder is apical ballooning syndrome or stress cardiomyopathy. The exact cause is unknown but thought to be related to a surge of stress hormones temporarily triggering changes in heart muscle cells or coronary blood vessels (or both) that prevent the left ventricle from contracting effectively. Individuals who experience it may also have a difference in the structure of their heart muscle. The sudden stress can be caused by stressful situations, extreme emotions, and serious physical illness or surgery. Some potential triggers are: the death of a loved one, a frightening medical diagnosis, domestic abuse, losing (or winning) a lot of money, strong arguments, a surprise party, public speaking, job loss, financial difficulty, divorce, asthma attack, COVID-19 infection, a broken bone or major surgery. Certain medications are thought to cause it as well. These include epinephrine, duloxetine, venlafaxine, levothyroxine, and unprescribed/illegal stimulants, such as methamphetamine and cocaine. It can happen even if you’re healthy.

Symptoms can occur within minutes or hours after a trigger and often mimic a heart attack. Symptoms include angina (sudden, severe chest pain), shortness of breath, arrhythmia (irregular beating of the heart), fainting, hypotension (low blood pressure), heart failure, and cardiogenic shock (an inability of the heart to pump enough blood to meet the body’s demands, which can be fatal if not treated quickly). Several factors elevate your chances of developing broken heart syndrome. It’s more likely to occur in women (especially after menopause), if you’re over 50, Asian/Caucasian, have a neurological disorder (ex. a head injury or a seizure disorder), or a previous/current psychiatric disorder.

It’s not just symptoms, but test results are similar to a heart attack, so it’s often misdiagnosed as a one. However, unlike a heart attack, there’s no evidence of blocked arteries. Heart attacks are generally caused by this, which happens due to a blood clot forming at the site of narrowing from fatty buildup (atherosclerosis) in the artery wall. In broken heart syndrome, arteries aren’t blocked, but blood flow may be reduced. If you look at the electrocardiogram (EKG) of a person with broken heart syndrome, it won’t look the same as one for a person having a heart attack. In addition, blood tests don’t show any signs of heart damage and imaging tests show no signs of blockages in the coronary arteries. Conversely, tests will show the ballooning and unusual movement of the left ventricle. Another key difference is the recovery time for broken heart syndrome is quick, usually within days or weeks compared to the recovery time of a month or more for a heart attack. Unlike a heart attack, there’s usually no lasting heart damage with broken heart syndrome.

There is no standard treatment for broken heart syndrome since it depends on the severity of symptoms. Treatment is similar to that for a heart attack until the diagnosis is evident. You’ll need to stay in the hospital and take heart medications, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, beta-blockers, or diuretics. These medications should reduce the workload on your heart while you recover and may help prevent further attacks. To ensure that your heart has recovered, you’ll need to have another EKG around four to six weeks after you first had symptoms. While most of the medications can be stopped after three months, it’s important to ask your doctor before doing this. Since there is no permanent damage to the heart in most cases, recurrence is unlikely. Death is rare, but heart failure occurs in about 20% of patients. Another serious complication is the backup of fluid into the lungs (pulmonary edema).

There isn’t anything specific you can do to prevent broken heart syndrome from occurring. Experts recommend learning stress management, problem-solving, and relaxation techniques to decrease the odds of having it. Some ways to reduce stress are exercise, meditation, and connecting with family and friends. It’s also a good idea to avoid poor lifestyle choices, such as drinking too much alcohol, overeating, illicit drug use, or smoking.

Broken heart syndrome was first described in 1990 in Japan. The advent of the EKG allowed it to be diagnosed as the cardiomyopathy that it is. It’s probably more prevalent than we once thought. According to the National Heart, Lung and Blood Institute, in 2007, about 12,000 people would have experienced broken heart syndrome. So, it isn’t a new disease; it’s just a new way of diagnosing it. After its discovery, many scientists started to research it in hopes of better understanding it.

In 2015, one group of researchers published their study results in the New England Journal of Medicine. They found that out of the 1,750 patients with Takotsubo cardiomyopathy they looked at, almost 90% were women, with a median age of 67. Other research suggests that 5% of women suspected of suffering from a heart attack actually have broken heart syndrome. The significance of this finding is key for a few reasons. One problem is most women don’t present with the typical signs of heart problems that men display. Also, they tend to downplay their symptoms, writing them off as stress or tension. Due to these factors, many women aren’t taken as seriously as they should be when they seek treatment. This is concerning since female broken heart syndrome patients are often over age 65, making them more susceptible to developing complications.

A study conducted in 2018 discovered that those diagnosed with broken heart syndrome were twice as likely to have complications if they also had a history of cancer. Compared to those without cancer, they were almost twice as likely to have experienced a physical trigger versus an emotional trigger. While they were just as likely to survive for 30 days after the syndrome began, cancer patients were more likely to die or require intensive heart and respiratory support while in the hospital and more likely to die within five years after. Researchers did point out that while there is a link between the two conditions, the study didn’t show that one causes the other. They further state that many of the risk factors between cancer and cardiovascular disease overlap, such as smoking, family history, poor diet, and lack of exercise. A different study published by the Journal of the American Heart Association noted that one in six people with broken heart syndrome had some form of cancer, with the most frequent type being breast cancer, followed by tumors affecting the gastrointestinal system, respiratory tract, internal sex organs, skin, and other areas.

Per a study in Diabetes Care, adults with diabetes who develop broken heart syndrome have mortality rates about twice as high as those who don’t have diabetes and end up with the condition. Researchers looked at patient data on 826 adults with broken heart syndrome from the German Italian Stress Cardiomyopathy Registry. The median age was 72, 83% were men, and 174 patients had type 2 diabetes. The information demonstrated that patients with diabetes were older, more likely to be male, and had a higher prevalence of hypertension and physical triggers than participants without diabetes. Those with diabetes were also more likely to have severely impaired left ventricular pumping and a higher rate of pulmonary edema resulting in longer hospital stays. In the short term (28 days), mortality didn’t differ significantly between patients with diabetes (6.4%) and those without (5.7%). However, after 2.5 years, patients with diabetes had a significantly higher mortality rate (31.4%) than those without (16.5%). Even after adjusting for other clinical risk factors, the data showed that diabetes remained a significant independent predictor of increased mortality.

A 2019 Swiss study noticed that broken heart syndrome is linked to the brain’s reaction to stress. For their research, a team of neuroscientists and cardiologists conducted MRI brain scans on 15 broken heart syndrome patients roughly about a year after their diagnosis and compared them to scans of 39 healthy people. The team specifically looked at four brain regions that control emotions, motivation, learning, and memory and share information with each other. Two regions, the amygdala and cingulate gyrus, help regulate the autonomic nervous system (controls the unconscious workings of the body) and heart function. In their analysis, researchers connected the function of those regions with the condition. Also, they found that these individuals had decreased communication between brain regions associated with emotional processing and the autonomic nervous system compared to healthy people. Since they didn’t have MRI scans of the affected patients’ brains when they developed the condition, the researchers couldn’t determine if the decrease in communication caused broken heart syndrome or developed because of it.

A concerning piece of information came from research about those with broken heart syndrome who end up with cardiogenic shock. For those who have this complication, the risk of death remains high not only while they’re in the hospital but for years afterward. The researchers analyzed statistics from a database of more than 2,000 patients on the International Takotsubo Registry. Of those, about 200, or 10%, developed cardiogenic shock. While in the hospital, about 24% of these patients died, which is much higher than those who didn’t acquire cardiogenic shock (2%). Even years later, a higher risk of death persisted for those who had cardiogenic shock. After five years, these individuals’ mortality rate was around 40%, compared with just 10% for those who didn’t experience it. The study also found that those who had cardiogenic shock tended to be slightly younger and more likely to have broken heart syndrome triggered by physical stressors. The patients with cardiogenic shock were more likely to have atrial fibrillation (an irregular heartbeat) and had higher rates of diabetes and other risk factors for heart disease. By taking these factors under consideration when examining a patient with broken heart syndrome, doctors might be able to better identify those at risk of developing cardiogenic shock.

The COVID-19 pandemic has increased the stress in many people’s lives, with many worrying about themselves/families becoming ill, combating loneliness due to isolation, and dealing with economic, emotional, and societal problems. According to researchers at the Cleveland Clinic, this has resulted in a significant rise in broken heart syndrome patients. In their study, cardiologists looked at 258 patients with heart symptoms known as acute coronary syndrome (ACS) between March 1st and April 30th and compared them with four control groups of ACS patients before the pandemic. The findings indicate there has been an escalation in patients diagnosed with broken heart syndrome. About 7.8% of patients were identified as having the condition compared with the pre-pandemic incidence of 1.7%. However, there was no significant difference in mortality between the groups. Interestingly, all of the patients diagnosed with the condition tested negative for COVID-19.

Some research is delving into potential treatments for broken heart syndrome. One study recently published in the American Heart Journal discovered that low-dose metoprolol and aspirin reduce the physiological and psychological risks of getting broken heart syndrome in early bereavement. The study had 85 recently bereaved participants (73 spouses and 12 parents). The researchers found that those on metoprolol and aspirin had lower systolic blood pressure levels, 24-hour average heart rate, anxiety, platelet response to arachidonic acid, and depression symptoms. There were no differences noted in bereavement intensity and no significant adverse safety impacts.

In March of this year, a study performed in Spain found propofol, a sedative used for anesthesia, may decrease the painful memories that come with heartbreak. In the study, participants were injected with the drug immediately after recalling a distressing story. When asked to recount it again 24 hours later, the memory was less vivid. The goal of the research was to relieve the symptoms of post-traumatic stress disorder (PTSD), but it seems there may be useful in suppressing other upsetting memories, like an unexpected loss. Some scientists argue that many of our unpleasant memories have helped shape who we are; so, they feel this wouldn’t be an acceptable method to help those with broken heart syndrome.

While broken heart syndrome might seem like something out of a children’s story, it’s not. It’s a real medical condition that can have serious impacts. If you have any symptoms of it, seek help immediately. While we don’t fully understand it yet, we’re gaining more and more insight as research continues. Hopefully, one day, we’ll have a way to prevent it from occurring. Until then, manage stress the best you can and make healthy lifestyle choices to reduce your chances of having the disorder.