Heartbreak can be a devastating experience at any age. When the man I thought was “the one” ended our relationship years ago, I felt as though I was experiencing a death. I could barely get out of bed, cried more often than not and moped around so miserably my friends grew weary of trying to distract me from my suffering. However, I was lucky — my heartbreak wasn’t literal.
Unfortunately, in some people’s cases, a breakup or other traumatic emotional stressor can be enough to cause physical damage to the heart, a syndrome known variously as takotsubo cardiomyopathy, stress-induced cardiomyopathy, or “broken heart syndrome.”
The syndrome was first noticed in Japan in 1990, where physicians discovered that people were presenting with the symptoms of a heart attack during initial testing. However, follow-up cardiac angiograms that look for the signature blood clots of a heart attack turned up clean.
“Cardiomyopathy means a weakening of the heart muscle, of the heart’s pump,” Satjit Bhusri, a cardiologist with Lenox Hill Hospital in New York, told me. Takotsubo is the Japanese term for a kind of pot specially designed to catch octopuses, of all things. When the Japanese researchers who first identified the syndrome examined the hearts of early patients, they saw “the same type of appearance as the takotsubo bowl,” Bhusri explained. “The apex or tip of the heart balloons out, and the base of the heart contracts normally.”
The syndrome may explain why couples who have been together for long periods of time often die within days of each other.
The condition got the nickname “broken heart syndrome,” however, when researchers began to notice that often an emotional or mental stressor, such as a loss of a loved one or a divorce, had preceded the symptoms.
Bhusri believes it’s possible that broken heart syndrome caused the death of actress Debbie Reynolds, the mother of actress Carrie Fisher, who died the day after Fisher passed away in late 2016. He also thinks it may explain why couples who have been together for long periods of time often die within days of each other.
In patients with broken heart syndrome, “the most common presenting symptoms are chest pain and shortness of breath,” says Zachary Goldberger, associate professor of medicine and a cardiologist at University of Washington’s School of Medicine. Patients also usually have an abnormal electrocardiogram, an abnormal echocardiogram and an elevated biomarker in their blood. Altogether, individuals with the syndrome present very much like they’re having a heart attack.
Only a cardiac angiogram will rule out an actual heart attack.
Even more fascinating, says Lenox Hill's Bhusri: “These patients have completely clean coronaries and their heart pumps resolve in anywhere from eight hours to two months.”
A patient had a heart attack and died. Then, suddenly, the patient’s daughter also collapsed at her mother’s bedside
While there is much researchers do not know about why and how this condition occurs, Bhusri says, is that these sort of attacks “are, more often than not, due to some type of stressor, either organic stress like a surgery, or an emotional stress.” However, the stressors can include a startling array of potential causes, ranging from a fierce argument, to a natural disaster, financial loss or receiving bad news such as a cancer diagnosis.
The syndrome can even be the result of a panic attack, as happened to one of Bhusri’s patients who collapsed at a big sale. “[it looked like a heart attack and it ended up being stress-induced cardiomyopathy.”
In another case, Bhusri was the attending cardiologist in the ER when a patient had a heart attack and died. Suddenly, the patient’s daughter also collapsed at her mother’s bedside. “She had what looked like a heart attack and ending up having broken heart syndrome,” Bhusri explains.
While the condition can occur in men as well as in women, 90% of those who suffer it are women, aged 58 to 75. This may have to do with changes that occur post-menopause, but researchers don’t have a conclusive answer for the stark gender divide.
Fortunately, Goldberger explains, the changes to the heart are “usually transient,” and the outcomes “generally very favorable.” But, he warns that “there can be severe consequences in some patients including sudden death,” as well as arrhythmias and cardiogenic shock, which may damage the heart beyond a quick recovery.
While the condition can occur in men as well as in women, 90% of those who suffer it are women.
Even though research still hasn’t pinpointed the exact causes, the syndrome is now considered a legitimate diagnosis.
“There’s a very significant brain-heart connection,” Goldberger says. The heart has many receptors that take commands directly from the brain. While our understanding of the condition is still growing, the general hypothesis is that under stress or trauma, the sympathetic nervous system releases a lot of neurotransmitters that are very much like adrenaline, he explains. “These hormones may be cardiotoxic, and may injure the heart muscle.”
Still, Bhusri says cardiologists have yet to fully understand how something like mental stress or a panic attack can result in “literally a broken heart.” Even more curious, Bhusri says he’s noticed what appears to be an increased prevalence of the condition. “I used to see it once a year but now I see it about every eight weeks,” he said.
Perhaps this means doctors are more aware of the syndrome and so are looking for it more? Or perhaps life is simply becoming more stressful.
If anything, the syndrome reveals that the link between our hearts and minds is much more literal, and fragile, than we may ever have imagined.