We talk about people dying of a broken heart. But does it really happen?
The answer is yes, but only very rarely, says Dr. Pranav M. Patel, MD, an interventional cardiologist and chief of cardiology at UCI School of Medicine.
More often, severe emotional or physical shock can cause people to experience heart-attack-like symptoms of chest pain, shortness of breath and irregular heartbeats that resolve fairly quickly.
Doctors call it stress-induced cardiomyopathy. It’s also known as takotsubo ardiomyopathy, named after the Japanese word for a pot used to fish for octopus that has a shape similar to the heart’s chamber. Colloquially, it is called broken-heart syndrome.
“We see it about once a month,” Patel says. “We think it’s caused by a surge of stress hormones following traumatic events, like the sudden death of a loved one, divorce or a traffic accident.”
Symptoms mimic a heart attack
According to the National Institutes of Health (NIH), nearly 90% of people who experience broken-heart syndrome are women. Most are in their 60s, although it does occur in men and people of all ages — even children.
“It’s amazing how anxiety, stress and depression can cause symptoms,” Patel says. “These people are experiencing heart-attack related symptoms, but they’re not really having a heart attack.”
However, the condition is sometimes misdiagnosed as one. That’s because patients experience chest pain, changes in heart rhythm revealed by an electrocardiogram, abnormal blood work and a weakening of the left ventricle of the heart.
Diagnosing broken-heart syndrome
“You can’t diagnose it based on symptoms,” Patel explains.
“But a cardiac catheterization, also known as a coronary artery angiogram, can reveal if there’s cholesterol blockage or not. In patients with broken-heart syndrome, we find that the arteries are completely open.”
In an angiogram, an interventional cardiologist inserts a tube through an artery in the groin or arm into the heart and injects a fluid containing dye. X-rays then reveal any blockages in the coronary arteries that supply blood to the heart.
Patel adds that cardiologists need to examine the patient’s complete clinical situation. Stress-induced cardiomyopathy usually affects the left ventricle of the heart, which is supplied by all three major heart blood vessels. That’s not typical of a heart attack, which usually results from one culprit blood vessel, but it is an indication of broken-heart syndrome.
An echocardiogram, which produces ultrasound pictures of the heart’s valves and chambers, can also help diagnose stress-induced cardiomyopathy.
Patel and his colleagues don’t typically wait for this test to be performed, however, opting instead for the gold-standard test of a coronary angiogram. Because time is of the essence, the sooner a diagnosis is made, the better for the patient, he says
Treating stress-induced cardiomyopathy
To treat broken-heart syndrome, cardiologists may prescribe medicines such as ACE inhibitors to lower blood pressure, beta blockers to slow the heart rate, diuretics to decrease fluid buildup or antianxiety medicines to manage stress. Some of these medications also help to strengthen the heart.
Broken-heart syndrome is a transient condition that usually improves quickly — within days or weeks — and it isn’t likely to recur or cause long-lasting damage.
But Patel suggests that symptoms could be an indication of something more serious.
“The last patient I saw had developed symptoms at her husband’s funeral,” Patel says.
“I wonder how many people experience stress-induced cardiomyopathy, but we don’t see them. People who have these symptoms should come in for an evaluation.”