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Broken heart syndrome

Overview

Broken heart syndrome is a temporary heart condition that's often brought on by stressful situations and extreme emotions. The condition can also be triggered by a serious physical illness or surgery.

People with broken heart syndrome may have sudden chest pain or think they're having a heart attack. Broken heart syndrome affects just part of the heart, temporarily disrupting the heart's usual pumping function. The rest of the heart continues to work properly or may even squeeze (contract) more forcefully.

The symptoms of broken heart syndrome are treatable. Broken heart syndrome usually reverses itself in days or weeks.

Broken heart syndrome may also be called:

  • Stress cardiomyopathy
  • Takotsubo cardiomyopathy
  • Apical ballooning syndrome

Symptoms

Broken heart syndrome signs and symptoms can mimic a heart attack and may include:

  • Chest pain
  • Shortness of breath

Any long-lasting or persistent chest pain could be a sign of a heart attack, so it's important to take it seriously and call 911 or emergency services if you have chest pain.

When to see a doctor

If you're having any chest pain, a very rapid or irregular heartbeat, or shortness of breath after a stressful event, call 911 or emergency medical assistance immediately.

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 squeezing (constriction) of the large or small arteries of the heart may play a role. People who have broken heart syndrome may also have a change in the structure of the heart muscle.

Broken heart syndrome is often preceded by an intense physical or emotional event. For example, an acute illness (such as an asthma attack or COVID-19 infection), major surgery or a broken bone can lead to broken heart syndrome. Anything that causes a strong emotional response, such as a death or other loss, or a strong argument may trigger this condition.

Rarely, use of certain drugs may lead to broken heart syndrome, including:

  • Emergency medications used to treat severe allergic reactions or severe asthma attacks
  • Some medications used to treat anxiety
  • Nasal decongestants
  • Illegal stimulant drugs, such as methamphetamine and cocaine

Always tell your health care provider about the medications you take, including those bought without a prescription. When starting a new medication, talk to your provider about the potential risks and side effects.

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. In broken heart syndrome, the heart arteries are not blocked, although blood flow in the arteries of the heart may be reduced.

Risk factors

Known risk factors for broken heart syndrome include:

  • Sex. Broken heart syndrome is more common in women than in men.
  • Age. It appears that most people who have broken heart syndrome are older than 50.
  • A previous or current mental health disorder. People who have anxiety or depression may have a higher risk of broken heart syndrome.

Complications

Rarely, broken heart syndrome can cause death. However, most people who have broken heart syndrome quickly recover and don't have long-lasting effects.

Other possible complications of broken heart syndrome include:

  • Backup of fluid into the lungs (pulmonary edema)
  • Low blood pressure (hypotension)
  • Irregular heartbeats (arrhythmias)
  • Heart failure
  • Blood clots forming within the heart due to the weakened heart muscle

Broken heart syndrome may occur again after another stressful event. However, the odds of this happening are low.

Prevention

To prevent another episode of broken heart syndrome, many health care providers recommend long-term treatment with beta blockers or similar medications that block the potentially damaging effects of stress hormones on the heart.

Some people who have chronic stress may have an increased risk for broken heart syndrome. Taking steps to manage emotional stress can improve heart health and may help prevent broken heart syndrome.

Diagnosis

To diagnose broken heart syndrome, the health care provider will usually perform a physical exam and ask questions about your symptoms and medical history. He or she may also ask if you've had any major stresses recently, such as the death of a loved one.

People who have broken heart syndrome usually don't have any heart disease symptoms before they're diagnosed with broken heart syndrome.

If your health care provider thinks you have broken heart syndrome, the following tests may be done to confirm the diagnosis:

  • Electrocardiogram (ECG or EKG). This quick test measures the electrical activity of the heart. Sticky patches (electrodes) are placed on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which shows the test results. An ECG can show if the heart is beating too fast, too slow or not at all. ECG results for broken heart syndrome look different than those for a heart attack.
  • Coronary angiogram. This test uses X-ray imaging to see the heart's blood vessels. During a coronary angiogram, dye is injected into the blood vessels of the heart. Then several X-ray images (angiograms) are taken. The dye helps the blood vessels show up more clearly on the X-rays.

    A coronary angiogram is done to rule out a heart attack. People with broken heart syndrome often don't have any blockages in the blood vessels, while people who've had a heart attack usually have a blockage that can be seen on an angiogram. Once it's clear that you're not having a heart attack, your health care provider will check to see if your signs and symptoms were caused by broken heart syndrome.

  • Echocardiogram. This noninvasive test uses sound waves to create images of the heart's size, structure and motion. It can show if the heart is enlarged or has an unusual shape, which may be a sign of broken heart syndrome.
  • Blood tests. People who have broken heart syndrome often have higher levels of substances called cardiac enzymes in the blood.
  • Cardiac magnetic resonance imaging (cardiac MRI). This imaging test uses a magnetic field and computer-generated radio waves to create detailed images of the structures of the heart.

Treatment

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

Many people with broken heart syndrome fully recover within a month or so. You'll likely need to have another echocardiogram around 4 to 6 weeks after you first had symptoms to be sure your heart has recovered.

Medications

Once it's clear that broken heart syndrome is the cause of the symptoms, medications may be prescribed to reduce the strain on the heart and prevent further attacks. Medications may include:

  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin II receptor blockers (ARBs)
  • Beta blockers
  • Diuretics
  • Blood thinners if there is a blood clot

Surgeries or other procedures

Surgeries and procedures that are often used to treat a heart attack — such as balloon angioplasty and stent placement or open-heart surgery — aren't helpful in treating broken heart syndrome. These procedures treat blocked arteries, which are not the cause of broken heart syndrome.

Preparing for an appointment

Broken heart syndrome is usually diagnosed in an emergency or hospital setting, since most people with the condition have symptoms identical to those of a heart attack.

Call 911 or emergency medical help or have someone drive you to an emergency room if you have new or unexplained chest pain or pressure that lasts for more than a few moments.

Have a family member or friend come with you, if possible. Someone who accompanies you can help remember all the information provided during your evaluation.

Share key information with the person taking you to the hospital:

  • Any symptoms you're having, and how long you've had them.
  • Your important personal information, including any major stresses, such as the death of a loved one, or recent life changes, such as the loss of a job.
  • Your personal and family medical history, including other health conditions that you or your blood relatives have had, such as diabetes, high cholesterol or heart disease. It's also helpful for your health care providers to know about any prescription and nonprescription medications you're taking.
  • Any recent injury to your chest that may have caused damage inside the body (internal injury), such as a broken rib or pinched nerve.

Once you're at the hospital, it's likely that you will be evaluated rapidly. Based on results from an electrocardiogram (ECG) and blood tests, your health care provider may be able to quickly determine if you are having a heart attack — or give you another explanation for your symptoms. You may have many questions at this time. If you haven't received the following information, you may want to ask:

  • What do you think is causing my symptoms?
  • I recently experienced the sudden death of a loved one. Could my symptoms be due to this event?
  • What kinds of tests do I need?
  • Will I need to stay in the hospital?
  • What treatments do I need right now?
  • What are the risks associated with these treatments?
  • Will this happen again?
  • Do I need to follow any restrictions in my diet or exercise routine after returning home?

Don't hesitate to ask any additional questions.

What to expect from the doctor

A health care provider who sees you for chest pain may ask:

  • What symptoms are you having?
  • When did these symptoms begin?
  • Does your pain spread to any other parts of your body?
  • Does your pain temporarily increase with each heartbeat?
  • What words would you use to describe your pain?
  • Does exercise or physical activity make your symptoms worse?
  • Do you have any history of heart problems in your family?
  • Are you being treated or have you recently been treated for any other health conditions?
Last Updated: November 24th, 2021