Elderly married couples have been known to die within hours or days of each other. Doctors sometimes treat patients with heart attack-like symptoms who have come directly from a funeral. In other words, a figurative broken heart can actually lead to a literal broken heart.
It’s called stress-induced cardiomyopathy, and it’s one of the more perplexing disorders for cardiologists. “It’s a fascinating condition,” says Dr. Chintan Desai, a cardiovascular disease specialist at Northwestern Medicine Regional Medical Group in Illinois. “We see it in people who have suffered severe emotional distress – a widow at her husband’s funeral, hearing a child is in a bad accident.”
Doctors have not completely unraveled the causes of the condition, also called broken heart syndrome. The symptoms are similar to a heart attack but are caused by a distinct process. “Our understanding is it is caused from adrenaline and other hormones related to adrenaline,” Desai says. “Whether that’s the whole story or not is not completely understood.”
An article in the June 2017 issue of the journal Circulation notes that positive and surprising news in a person’s life can also trigger the syndrome. Think winning the lottery, or a son or daughter who comes home from war to surprise a parent. According to the article: “Recently it has been shown that [stress-related cardiomyopathy] can occur after a positive life event, hence the recently proposed term happy heart syndrome.”
Regardless of whether it’s triggered by good news or bad, stress-induced cardiomyopathy occurs when acute stress leads to heart muscle distress. The left ventrical, the heart’s main pumping chamber, becomes weak and balloons out, leaving the heart unable to pump enough blood. The condition, first named in Japan in 1990, was described as takotsubo cardiomyopathy because the enlarged left ventrical resembles a Japanese octopus trap called takotsubo.
Doctors say the condition, now often called takotsubo cardiomyopathy, is not uncommon. “We’ve all seen a bunch of them,” says Dr. Pamela S. Douglas, Ursula Geller Professor of Research in Cardiovascular Diseases in the Department of Medicine at Duke University and director of the Multimodality Imaging Program at Duke Clinical Research Institute. “It’s not as rare as you might think it is.”
More than 90 percent of cases occur in women ages 58 to 75, according to Harvard Women’s Health Watch, a publication of Harvard Medical School. Up to 5 percent of women evaluated for a possible heart attack actually have stress-related cardiomyopathy. Researchers believe older women are more vulnerable because of a drop in estrogen after menopause.
Symptoms of stress-related cardiomyopathy are almost identical to a heart attack – sudden chest pain and shortness of breath – but the process that causes the event is quite different.
In a typical heart attack, the heart can’t get enough oxygen and blood because one or more arteries that lead to the heart are blocked by plaque and cholesterol. This prevents the heart from pumping effectively. During stress-induced cardiomyopathy, the heart is also pumping incorrectly, but the arteries are open and healthy, with mild or negligible signs of coronary artery disease. Doctors believe that stress hormones, not clogged arteries, cause the heart to pump inadequately. “A surge in stress hormones stuns the heart and creates changes in blood flow,” Douglas says. “It makes the heart stop squeezing effectively.”
Broken heart syndrome is usually diagnosed in an emergency room because the patient needs urgent care.
An electrocardiogram, or EKG, which measures the heart’s electrical activity, will often show the same abnormalities for patients who are having a heart attack as it does for those suffering from broken heart syndrome. In order to rule out a heart attack, doctors take images of the heart using a test such as a diagnostic cardiac ultrasound. About 20 percent of patients who experience broken heart syndrome have heart failure, according to Harvard Women’s Health Watch.
Another significant difference between a heart attack and broken heart syndrome is that a person experiencing a stress-related heart event will not have the same risk factors as a heart-attack victim, such as high blood pressure and narrowed arteries, and will also present as healthy prior to the heart muscles weakening. Because of that, people who suffer from stress-related cardiomyopathy recover quickly as long as they survive the event. The heart generally returns to normal within several weeks. “By definition, it gets better and normalizes over time,” Desai says.
Stress-induced cardiomyopathy is treated with standard medications that treat heart failureand improve the heart’s contraction function. Examples are ACE inhibitors, which correct blood flow and decrease the heart’s workload; beta blockers, which slow heart rate and reduce blood pressure; and diuretics, which prevent fluids from collecting in the body.
Treatment is evolving as doctors learn more about the condition. And unlike a heart attack, if someone has had stress-induced cardiomyopathy, it’s unlikely to occur twice. “It’s possible that you may have broken heart syndrome again if you have another stressful event,” according to the Mayo Clinic’s website. “However, the odds of this happening are low.”