Ask an expert: What is broken-heart syndrome?

If you thought the pain of a broken heart was strictly an emotional response, think again.

For some people, a traumatic event or memory can trigger the physical symptoms of “broken-heart syndrome.” Also known as stress-induced cardiomyopathy, takotsubo cardiomyopathy, or apical ballooning syndrome, it’s a condition in which heart muscle becomes acutely weak and then fully recovers a few days later.

We asked Milena A. Gebska, MD, PhD, a board-certified cardiologist with University of Iowa Heart and Vascular Center, to explain this disorder and what lies at the heart of the problem.

What happens during “broken-heart syndrome?”

We still don’t fully understand the mechanism of this specific type of acute heart failure syndrome. Evidence points to a strong brain-heart interplay. We believe that within a few hours of an extreme emotional or physical trauma, stress hormones cause transient (short-lived and not permanent) “stunning” of the left ventricle, which is the main heart chamber that pumps blood out to the rest of the body. As a result, the heart becomes temporarily “frozen” and cannot pump enough blood forward. This causes poor circulation and even shock, or death, in more extreme cases.

What’s fascinating is the fact that stress-induced cardiomyopathy, despite its serious presentation, is usually rapidly reversible. The ventricle typically returns to normal within 14 days, and most patients recover with no long-term heart damage.

What does “takotsubo” mean?

In 1990, a Japanese physician used the term after imaging the heart of an affected patient and seeing this misshapen ventricle that had ballooned out instead of contracting during systole (the part of the heart’s pumping cycle when it pushes blood out to the rest of the body) It resembled the shape of a “tako-tsubo,” a ceramic pot Japanese fishermen use to trap octopus.

What are the symptoms?

Patients with stress-induced cardiomyopathy usually experience symptoms that are indistinguishable from acute coronary syndrome—chest pain or pressure, shortness of breath, dizziness, low blood pressure, rapid heartbeats, or nausea. It’s like a heart attack, which is why patients with these symptoms should seek medical attention and be monitored, especially during the acute phase. Patients typically spend at least 48 hours in the hospital and are treated with medications to help the heart heal. Coronary angiography (a test that uses dye injection directly to heart vessels and special X-rays) is required to prove the diagnosis. Despite the symptoms of a weak heart, no blockages are seen in the heart blood vessels with stress-induced cardiomyopathy, unlike those patients who experience a real heart attack.

What can cause this to occur?

Severe physical and emotional stressors—the death of a loved one, a catastrophic event, financial loss, a serious medical condition, a car accident, or an emotional memory or anniversary—have been well known to cause transient heart stunning.

Who is most likely to develop this condition?

It appears primarily to affect women, especially women who are over age 55. Researchers believe that postmenopausal women are more vulnerable because of lower levels of estrogens. It’s estimated that among women who present with symptoms of acute coronary syndrome, about 5 percent will have stress-induced cardiomyopathy instead. And there are probably a lot of women who experience minor symptoms and never seek medical attention, so the condition can be missed.

The connection between emotion and cardiac death has long been documented in the medical literature, and there have been many reports of seemingly healthy people who have dropped and even died during a natural disaster or traumatic event. To date, takotsubo syndrome continues to fascinate physicians and remains an unsolved medical mystery.