The Power of Emotions in Broken Heart Syndrome

Broken heart syndrome, or Takotsubo cardiomyopathy, is a form of heart strain that can develop as a result of severe emotional or physical stress. This condition is different from a heart attack, but it can be just as dangerous, even fatal.

The symptoms of this stress-induced weakening of the heart can mimic a heart attack and include angina (chest pain), shortness of breath, and an irregular heartbeat. However, cardiac tests will not uncover blockages or other changes that healthcare providers expect to see during a heart attack.

This article explores broken heart syndrome, how it feels, how it's diagnosed, and what to expect regarding treatment and recovery.

Broken Heart Syndrome, Stress, and Chest Pain: What’s the Link?

Broken heart syndrome is a type of cardiomyopathy, a condition that occurs when your heart muscles get weak and less effective in pumping blood throughout your body. Many types of cardiomyopathy exist, each with specific causes or risk factors.

Broken heart syndrome is known as stress-induced or Takotsubo cardiomyopathy because it develops from intense emotional or physical stress.

In stressful events, such as the loss of a loved one or a natural disaster, stress hormones called catecholamines build up to toxic levels in the body. The exact mechanisms that cause broken heart syndrome aren't entirely understood, but catecholamines are believed to play a significant role. These hormones lead to oxidative stress and changes in calcium levels and blood flow that can cause symptoms like chest pain and shortness of breath.

During a heart attack, a blood clot or blockage prevents the normal amount of blood flow through the chambers of your heart, leading to chest pain. In broken heart syndrome, stress changes how your heart works (often temporarily), resulting in the same kind of pain. Broken heart syndrome does not result from a blockage.

Heart and Chest Symptoms

People who develop broken heart syndrome usually end up in a hospital emergency department due to its similarity to a heart attack in terms of symptoms and presentation, including:

• Chest pain
• Shortness of breath
• Irregular heartbeat (arrhythmia)

While at the hospital, healthcare providers will run testing to determine the cause of your symptoms. They will look at the results of an electrocardiogram (ECG or EKG) and blood tests to see whether you had a heart attack or if they should investigate other potential causes.

How to Treat Broken Heart Syndrome

Nearly 9% of cases of broken heart syndrome lead to death, but for many others, the condition is temporary. Recovery from broken heart syndrome typically takes a few weeks. Still, there is also a chance that you could develop long-term heart problems after an acute episode of Takotsubo cardiomyopathy.

Effective treatment for broken heart syndrome begins with an accurate diagnosis, which can be challenging.

Hospitalization and Emergency Treatment

Treatment for broken heart syndrome is done with medications, not surgeries, to relieve symptoms and prevent additional problems. Some medicines that are used to treat this type of cardiomyopathy include:

• Beta-blockers to boost left heart function
• Angiotensin converting (ACE) inhibitors to improve blood flow, relax the heart muscle, and lower blood pressure
• Blood thinners and antiplatelet medications to prevent blood clots
• Statins and other cholesterol-lowering drugs to help control blood pressure and additional blockages
• Levosimendan, which increases your heart's sensitivity to calcium and reduces the workload on your heart

Different treatments and prolonged hospitalization might be necessary if you develop other complications from broken heart syndrome, such as:

• Cardiogenic shock: A sudden drop in blood flow caused by heart dysfunction
• Heart failure: A permanent reduction in the function of your heart muscle
• Blood clots: Groups of blood cells that can collect and block blood flow
• Arrhythmias: Changes in the natural rhythm of your heart that could lead to severe problems or death

Some medications used in the treatment of early or acute broken heart syndrome must be given intravenously (by IV) in the hospital. If you require ongoing treatment with drugs like beta blockers or ACE inhibitors, these may be continued as oral medications once you can go home.

Causes, Triggers, and Increased Risk Factors

Broken heart syndrome can be a misleading name for Takotsubo cardiomyopathy. Although extreme emotional stress can trigger the condition and is most commonly associated with this kind of cardiomyopathy, a study from 2020 reveals that more recent evidence points to physical triggers as the most common cause.

Examples of physical triggers that have been associated with broken heart syndrome are:

• Trauma, surgery, asthma attacks, or natural disasters (i.e., events that cause a rush of adrenaline)
• Microvascular diseases that affect the health of your blood vessels
• Chronic conditions contributing to physical stress (e.g., diabetes and depression)
• Certain medications, such as specific combinations of ACE inhibitors and beta-blockers, some antidepressants and antiarrhythmic drugs, and chemotherapy
• Psychiatric conditions (e.g., anxiety and substance use disorders)
• Hormonal changes
• Genetic disorders

Ruling Out Heart Attack vs. Broken Heart Syndrome Diagnosis 

Since the set of symptoms for broken heart syndrome is the same as acute cardiac syndrome (ACS), several tests will be done first to diagnose and possibly rule out a heart attack. This can include basic cardiac tests like:

• ECG
• Blood tests to check cardiac enzymes
• Angiography or other procedures to directly examine the structure and blood flow in the heart

You may require multiple rounds of testing to rule out a heart attack or other cardiac issues that can also appear with chest pain. Once those conditions are ruled out, other diagnoses, like broken heart syndrome, may be considered and treated.

Recovery Timeline at Start of Treatment 

About 90% of people who develop broken heart syndrome recover in four to eight weeks. Relapses or recurrences do happen, but they usually occur in people who have had complications at the start of their disease or who have other complex medical conditions.

Some of the long-term issues that people with broken heart syndrome have been known to develop as a result of their cardiomyopathy include:

• Decreased function on the left side of the heart
• Heart attack
• Relapses of their cardiomyopathy
• Heart failure

Certain conditions could make you more likely to develop complications with broken heart syndrome, such as:

• Chronic kidney disease
• Coronary artery disease
• Reduced heart function before broken heart syndrome
• Shortness of breath as an early symptom of broken heart syndrome

Managing Emotions and Stress

Emotional stress can contribute to broken heart syndrome. It's essential to your mental and physical health to find ways to manage stress, anxiety, and other types of emotional strain.

If you are at risk of developing broken heart syndrome or you have experienced it already, it's essential to work with a cardiologist and psychiatrist to reduce your risk of recurrence and other complications.

Summary

Broken heart syndrome is a problem you might develop if you're under severe physical or emotional stress. The stress hormones in your body can contribute to cardiomyopathy or a weakening of the heart. Stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy or broken heart syndrome, can be fatal. However, most people who experience broken heart syndrome recover within a few months.