Broken heart syndrome is a form of heart muscle disease, or cardiomyopathy, which can occur during intense emotion, such as separation or death of a loved one, or other traumatic experiences, such as a car accident, severe pain, after surgery or even during anger. Positive experiences can also cause this syndrome, such as winning a competition or the Lotto prize pool. What are its symptoms and treatments and why does it affect women more?

The syndrome was only first described in the 1990s by Japanese cardiologists. They called it TakoTsubo cardiomyopathy (TTC), after a ceramic pot used by Japanese fishermen to trap octopuses. It is a convex container with a narrow neck that prevents the octopus from coming out. During contraction, the heart takes the form of this trap: the tip of the heart (apex) stops moving (“akinesia”) and inflates like a balloon.

Broken heart syndrome is also called “stress cardiomyopathy”.

What causes the broken heart syndrome?

Tako-Tsubo cardiomyopathy is usually caused by an intense and stressful physical or emotional event, such as the death of a loved one, a divorce, a dismissal, a accident, or conversely an unexpected happy episode.

Other causes are possible:

• A traumatic physical event: an epilepsy attack, a severe asthma attack, acute pain, surgery, subarachnoid hemorrhage
• Medicines, adrenaline injected during an allergic reaction and certain antidepressants.
• Drugs like cocaine or a drug rehab.

Symptoms appear suddenly and almost immediately after the stressful event. However, it’s not yet known whether chronic stress could also cause the syndrome. And on the other hand, the syndrome could sometimes occur independently of a stressful event.

The risk factors

The mechanism is not yet very clear. We know that during an emotionally strong and/or very stressful experience, large quantities of stress-related hormones (catecholamines, like adrenaline) are released into the blood. This starts a complex process, with the ultimate consequence of a temporary freezing of the heart muscle cells and a disorder of the contractility of the left ventricle. The base of the heart continues to pump, but the tip is stationary and swells.

• A genetic predisposition is possible, with a greater sensitivity to stress hormones, but this avenue is being studied.
• A neurological disorder could cause abnormal contractions of blood vessels under the influence of stress.
• There are indications that the syndrome occurs primarily in people with an anxiety disorder or other mental problems.
• The disorder also seem to occur mainly in the morning and more often at the beginning of summer.

Why mostly women?

In nine out of ten cases, broken heart syndrome affects women, especially after menopause, and the risk increases with age. Among women hospitalized for suspected myocardial infarction, 10% actually suffer from broken heart syndrome.

It is believed that the heart cells of postmenopausal women are more sensitive to stress hormones due to a much lower estrogen level. It could also be that men’s heart cells are richer in adrenaline receptors, with better resistance to stress.

What are the symptoms?

The symptoms of the broken heart syndrome are very similar to those of a myocardial infarction.

• feeling of tightness or pain in the chest
• dyspnea (breathing difficulties)
• palpitations

The big difference between broken heart syndrome and myocardial infarction is that in the case of an infarction, the coronary arteries are narrowed or even blocked.

A second important difference is that during an infarction, the heart muscle is damaged. During broken heart syndrome, the heart recovers fairly quickly, while following a heart attack, revalidation takes several months, and the damage is often permanent.

Prognosis

Broken heart syndrome is generally a temporary phenomenon which is completely healed after a few days or weeks, without permanent damage. The probability of suffering from Tako-Tsubo again is quite low, although it cannot be excluded.

Complications occur, however, in 20% of cases: sudden drop in blood pressure followed by cardiogenic shock (which can be life-threatening), water in the lungs (pulmonary edema), embolism, cardiac arrhythmia, etc. are the main reasons why a patient will have to be hospitalized in intensive care during the first days. It is estimated that approximately 1% of patients hospitalized for broken heart syndrome die from it.

In addition, broken heart syndrome may slightly increase the risk of suffering from a stroke later in life.

How is it diagnosed

The purpose of a medical test is to distinguish broken heart syndrome from myocardial infarction, both of which share the same symptoms.

• The electrocardiogram (ECG). Recording the electrical activity of the heart muscle provides information on heart function, heart rate, volume and functioning of the ventricles, and oxygen supply. It is this examination which, most of the time, highlights the abnormality of the left ventricle.
• The blood test to detect abnormal values.
• The radiography to visualize the volume of the heart.
• Echocardiography: a painless examination which makes it possible to observe the heart by the emission of ultrasound. Doctors can assess the pumping function of the heart and detect anomalies, such as the suspect form of the left ventricle.
• Coronary angiography (coronography), whose purpose is to locate narrowing in the coronary arteries. It consists of introducing a catheter (small probe) into a blood vessel in the groin or arm and guiding it to the heart. Once the catheter is in place, a contrast agent is injected into the coronary arteries so that doctors can see, through radiographic images, the blocked or narrowed sections. The exam also checks the condition of the heart muscle. Unlike a heart attack, broken heart syndrome is not related to obstruction of the coronary arteries.
• MRI (magnetic resonance) allows to visualize the heart muscle and the coronary arteries.

Treatments of Broken Heart Syndrome

The treatment is similar to that of myocardial infarction, but the duration is significantly shorter and will be determined by how quickly the left ventricle contracts again normally. As a rule, it only lasts a few days, sometimes a few weeks.

Medications, such as beta blockers and/or ACE inhibitors, help support the restoration of heart function. An anticoagulant may be prescribed temporarily.

In case of complications, such as too low blood pressure or pulmonary edema, treatment will be prescribed, for example a diuretic.

Long-term treatment is rarely necessary. If the left ventricle is not functioning optimally, the doctor may prescribe specific medications, such as a beta blocker.

Since Tako-Tsubo cardiomyopathy is often caused by stress, it is important to avoid stressful situations and learn to manage them.

Finally, the patient may have to follow a cardiac revalidation program.