Broken Heart Syndrome Can Be Life-Threatening

Broken heart syndrome, also called stress-induced cardiomyopathy or takotsubo cardiomyopathy, can strike even if you’re healthy. (Tako tsubo, by the way, are octopus traps that resemble the pot-like shape of the stricken heart.)

Women are more likely than men to experience the sudden, intense chest pain — the reaction to a surge of stress hormones — that can be caused by an emotionally stressful event. It could be the death of a loved one or even a divorce, breakup or physical separation, betrayal or romantic rejection. It could even happen after a good shock (like winning the lottery.)

Broken heart syndrome may be misdiagnosed as a heart attack because the symptoms and test results are similar. In fact, tests show dramatic changes in rhythm and blood substances that are typical of a heart attack. But unlike a heart attack, there’s no evidence of blocked heart arteries in broken heart syndrome.

In broken heart syndrome, a part of your heart temporarily enlarges and doesn’t pump well, while the rest of your heart functions normally or with even more forceful contractions.

Causes

The exact cause of broken heart syndrome is unclear. It's thought that a surge of stress hormones, such as adrenaline, might temporarily damage the hearts of some people. How these hormones might hurt the heart or whether something else is responsible isn't completely clear. A temporary constriction of the large or small arteries of the heart may play a role.

Broken heart syndrome is often preceded by an intense physical or emotional event. Some potential triggers of broken heart syndrome are:

• News of an unexpected death of a loved one
• A frightening medical diagnosis
• Domestic abuse
• Losing a lot of money
• Natural disasters
• A surprise party
• Having to perform publicly
• Job loss
• Divorce
• Physical stressors, such as an asthma attack, a car accident or major surgery

It's also possible that some drugs, rarely, may cause broken heart syndrome by causing a surge of stress hormones. Drugs that may contribute to broken heart syndrome include:

• Epinephrine (EpiPen, EpiPen Jr), which is used to treat severe allergic reactions or a severe asthma attack
• Duloxetine (Cymbalta), a medication given to treat nerve problems in people with diabetes, or as a treatment for depression
• Venlafaxine (Effexor XR), which is a treatment for depression
• Levothyroxine (Synthroid, Levoxyl), a drug given to people whose thyroid glands don't work properly

How is broken heart syndrome different from a heart attack?

Heart attacks are generally caused by a complete or near complete blockage of a heart artery. This blockage is due to a blood clot forming at the site of narrowing from fatty buildup (atherosclerosis) in the wall of the artery. In broken heart syndrome, the heart arteries are not blocked, although blood flow in the arteries of the heart may be reduced.

Symptoms

People experiencing takotsubo cardiomyopathy will often have chest pains and breathlessness similar to those seen in a heart attack, according to the British Heart Foundation (BHF).

However, the survival rate for those who are discharged from hospital after suffering from the condition is nearly 100 per cent. Amy Thompson, Senior Cardiac Nurse at the BHF told The Independent: "Its symptoms can mimic a heart attack, but it causes no permanent damage to the heart - it is both temporary and reversible."

Diagnosis

Clues that may help lead your doctor to the right diagnosis are your age and gender. More than 90% of cases reported thus far have been in women.

It's especially common after menopause. Some research suggests that about 2% of people who seem to be having a heart attack actually have broken heart syndrome. Among women, the number may be higher than 5%, Wittstein tells WebMD.

If you've just gone through grief, stress, or emotional trauma, mention it to your doctor, Wittstein says. Also bring up recent physical stress such as an asthma flare-up or low blood sugar, he says. These can also trigger the problem.

To diagnose broken heart syndrome, doctors usually perform an angiogram. This provides images of the major blood vessels that supply your heart. During a heart attack, one or more arteries are often blocked. But during broken heart syndrome, these blood vessels look OK. 

Your doctor is likely going to want to also perform an echocardiogram. This takes pictures of your heart, which may reveal the tell-tale fishing pot shape.

Treatment

There are no standard treatment guidelines for treating broken heart syndrome. Treatment is similar to treatment for a heart attack until the diagnosis is clear. Most people stay in the hospital while they recover.

Once it's clear that broken heart syndrome is the cause of your symptoms, your doctor will likely prescribe heart medications for you to take while you're in the hospital, such as angiotensin-converting enzyme (ACE) inhibitors, beta blockers or diuretics. These medications help reduce the workload on your heart while you recover and may help prevent further attacks. Many patients make a full recovery within one to two months. Ask your doctor how long you will need to continue taking these medications once you recover, as most can be stopped after a while.

Procedures that are often used to treat a heart attack, such as balloon angioplasty and stent placement, or even surgery, are not helpful in treating broken heart syndrome. These procedures treat blocked arteries, which are not the cause of broken heart syndrome. However, coronary angiography is often used to diagnose exactly what's the cause of the chest pain.

Prevention

There's a small chance that broken heart syndrome can happen again after a first episode. There's no proven therapy to prevent additional episodes; however, many doctors recommend long-term treatment with beta blockers or similar medications that block the potentially damaging effects of stress hormones on the heart. Recognizing and managing stress in your life also is very important.