When the phrase “broken heart” comes to mind, you may think of a picture or drawing of a heart ripped in half with jagged edges running down the middle of each side. This image has come to symbolize the emotional distress that accompanies traumatic events such as the death of a loved one or the end of a long-term relationship.
But did you know such trauma could actually trigger a real cardiac condition known as broken heart syndrome? First described in the 1990s in Japan, broken heart syndrome occurs during periods of sudden and severe emotional or physical stress, which can cause the rapid weakening of the heart muscle. Also referred to as takotsubo syndrome or stress cardiomyopathy, the condition can feel like a heart attack, but there’s no indication of blocked arteries.
The good news is that broken heart syndrome is usually treatable, but it’s important to know the signs so you can get help. Read on to learn more about the symptoms of broken heart syndrome, its causes, how it’s diagnosed, treatment options, and what you can do to prevent it.
Signs and Symptoms of Broken Heart Syndrome
Symptoms of broken heart syndrome resemble those of a heart attack. According to the Cleveland Clinic, they typically occur within minutes or hours of the traumatizing event.
The main signs of broken heart syndrome include:
- Sudden chest pain
- Shortness of breath
Other symptoms can include:
- Arrhythmias, or irregular heartbeats
- Low blood pressure
Causes and Risk Factors of Broken Heart Syndrome
Researchers are still working to uncover exactly what causes broken heart syndrome. According to a research paper published in StatPearls, the most likely explanation is that the sudden release of stress hormones that accompanies intense emotional or physical trauma triggers changes to the cells responsible for the contraction of the heart.
About one-fourth of all cases have no known trigger, but unexpected stressful events tend to bring on the condition. These can include:
- The sudden death of a loved one
- Natural disaster
- An accident or major physical trauma
- The dissolution of a relationship
- Domestic violence
- Receiving a serious, acute medical diagnosis, such as cancer or a terminal illness
- Severe financial loss
- An intense argument
- Extreme fear
- Exhausting physical exertion
- Use of illicit drugs, such as cocaine or excessive stimulants
There are several known risk factors for broken heart syndrome including:
- Female sex The majority of people who experience broken heart syndrome are female.
- Older age Broken heart syndrome is more commonly seen in adults over the age of 50.
- Mental health conditions Individuals living with anxiety or depression have a higher risk of broken heart syndrome.
How Is Broken Heart Syndrome Diagnosed?
If you present to a doctor or emergency department with signs of broken heart syndrome, it’s important to rule out a heart attack. Your provider will complete a physical exam and review your medical history before ordering several tests, which may include:
- Electrocardiogram (EKG), which measures the heart’s electrical activity and shows how fast or slow the heart beats. An EKG can show if you’re having a heart attack, but can also signal broken heart syndrome.
- Coronary angiogram, which checks for blockages in the arteries, which would signal a heart attack. If no blockages are present and a heart attack has been ruled out, your doctor will look for signs of broken heart syndrome.
- Blood work to test for elevated levels of specific enzymes that signal broken heart syndrome
- Echocardiogram, which utilizes sound waves to display images of your heart. Doctors can check if the heart is enlarged or irregular in shape, which can be signs of broken heart syndrome.
- Heart MRI, which uses magnetic resonance imaging to create detailed pictures of the heart
Prognosis of Broken Heart Syndrome
The majority of people make a full recovery from broken heart syndrome, according to the American Heart Association (AHA). Because the heart muscle doesn’t suffer any permanent damage, the likelihood of a long-term heart issues is low. It’s also unlikely to recur.
In rare instances, broken heart syndrome can be fatal. About 1 percent of all cases lead to death, per Cleveland Clinic.
Duration of Broken Heart Syndrome
Most people make a full recovery from broken heart syndrome within four to six weeks after the first symptoms appear, Mayo Clinic reports.
But some people do experience complications, including low energy levels for months after their diagnosis.
Treatment and Medication Options for Broken Heart Syndrome
There’s no cure for broken heart syndrome and no set standard of treatment. Doctors typically treat the condition as they would a heart attack and patients usually stay in the hospital until they feel better.
Medications to treat broken heart syndrome include:
- ACE (angiotensin-converting enzyme) inhibitors, which prevent a specific enzyme in the body from narrowing blood vessels, thereby allowing better blood flow
- ARBs (angiotensin receptor blockers), which block the action of specific hormones on the heart and blood vessels to prevent damage
- Aspirin, to improve circulation and prevent blood clots
- Beta-blockers, which slow down the heart rate
- Water pills, or diuretics, to remove water from the body and decrease fluid buildup
Prevention of Broken Heart Syndrome
No interventions have been proven to prevent broken heart syndrome. But since sudden distress is a known risk factor, it may be helpful to learn ways to manage stressful situations. This can include relaxation techniques like meditation, yoga, and deep breathing; connecting with others who are going through similar traumatic or stressful events through support groups; and seeking professional help through a counselor or therapist.
Healthy lifestyle habits can also keep your heart strong. These include:
- Exercise. The Centers for Disease Control and Prevention (CDC) recommends at least 150 minutes of physical activity per week.
- Eat a heart-healthy diet. For a healthy heart, the AHA advises sticking to a Mediterranean diet, which focuses on fruits, vegetables, whole grains, nuts, seeds, and lean proteins.
- Don’t smoke tobacco.
- Prioritize sleep. Adults should aim to get seven to nine hours of sleep per night, the CDC advises.
- Keep up with doctor’s appointments. Stay up-to-date on medical appointments and screenings.
Complications of Broken Heart Syndrome
The majority of people with broken heart syndrome recover completely and don’t have any lasting effects. Complications are rare, but when they do occur, they may include:
- Low blood pressure
- Arrhythmias, or irregular heart beats
- Blood clots
- Pulmonary edema, a condition that occurs when fluid backs up into the lungs
- Heart failure
In very rare instances, broken heart syndrome can cause death.
Research and Statistics: How Many People Have Broken Heart Syndrome?
The true prevalence of broken heart syndrome is unknown, but research studies estimate the incidence is 1 to 2 percent of all patients suspected of heart attack.
According to a study published in October 2021 in the Journal of the American Heart Association, 88 percent of all cases of broken heart syndrome occur in females. The risk of broken heart syndrome is highest among adults older than 50, per the same study.
Black Americans and Broken Heart Syndrome
Research examining racial differences in prevalence and outcomes of broken heart syndrome is limited. One study suggests Black Americans experience a higher incidence of complications from the condition.
The research, published in June 2020 in the journal ESC Heart Failure, examined health data on more than 97,000 Americans with a diagnosis of broken heart syndrome from 2006 to 2014. The researchers compared the impacts of the condition on white Americans and Black Americans. The analysis showed that Black Americans were more likely to experience complications, including cardiac arrest, invasive mechanical ventilation, kidney injuries, and longer hospital stays than white Americans. The study authors concluded that it’s not that broken heart syndrome has a greater impact on Black Americans, but that these racial disparities could be attributed to other factors, including socioeconomic factors, such as income and health insurance status, as well as coexisting health conditions.
Related Conditions and Causes of Broken Heart Syndrome
Since stress is a major trigger of broken heart syndrome, conditions associated with stress, including depression and anxiety, come with a higher risk. Symptoms of broken heart syndrome are very similar to a heart attack. Here’s what you should know about both.
Depression and Anxiety Disorders
Researchers are still working to better understand the causes and risk factors for broken heart syndrome, but it’s clear acute emotional or physical stress plays a role. Since stress is strongly associated with psychiatric disorders like depression and anxiety, those living with these mental illnesses have a higher likelihood of broken heart syndrome, according to a research review published in September 2020 in Cureus. Per the review, treatment of these disorders with therapies like cognitive behavioral therapy and selective serotonin reuptake inhibitors (SSRIs) could reduce the risk of broken heart syndrome.
The symptoms of broken heart syndrome mimic those of a heart attack, which occurs when blood flow to the heart is partially or completely blocked. A heart attack is a very serious heart event and treatment is needed right away to prevent complications and death. Therefore, it’s important to know the signs of a heart attack so you know when to seek help. These include:
- Chest pain, which may feel like squeezing, pressure, or tightness
- Pain that spreads to the shoulder, back, neck, or arms
- Shortness of breath
- Dizziness or feeling faint
- Cold sweat
If you or a loved one experiences these symptoms, call for emergency medical help right away.