Broken heart syndrome

Broken heart syndrome is a heart condition that's often brought on by stressful situations and extreme emotions. The condition also can be caused by a serious physical illness or surgery. Broken heart syndrome is usually short-lived. But some people may still feel unwell after their heart is healed.

People with broken heart syndrome may have sudden chest pain. They may think they're having a heart attack.

Medicines are used to treat symptoms of broken heart syndrome.

Broken heart syndrome also may be called:

• Stress cardiomyopathy.
• Takotsubo cardiomyopathy.
• Recurrent takotsubo cardiomyopathy.
• Apical ballooning syndrome.

Symptoms of broken heart syndrome can be like those of a heart attack. Symptoms may include:

• Chest pain.
• Shortness of breath.
• Fainting.

When to see a doctor

New or unexplained chest pain can be a symptom of a heart attack. Get help right away if you think you're having a heart attack. Call 911 or your local emergency number. Also call for help if you have a very fast or irregular heartbeat or shortness of breath.

The exact cause of broken heart syndrome is not clear. It's thought that it may be caused by a sudden rise in stress hormones, such as adrenaline. The body releases these hormones when you go through something very stressful or upsetting. How these hormones might hurt the heart isn't completely clear.

Other things might be involved too. For example, broken heart syndrome might happen when the large or small arteries of the heart squeeze too tightly for a short time. Some people with broken heart syndrome also have slight changes in their heart muscle.

Most often, broken heart syndrome happens after something physically stressful or very emotional.

Physical stress may include:

• Serious infection such as COVID-19.
• Sudden illness such as an asthma attack.
• Sudden lung failure, also called acute respiratory failure.
• Major surgery.
• Anything that causes sudden pain, such as a broken bone.

Emotional stress may include:

• Death of a loved one or other loss.
• Strong argument.
• Serious money trouble or other financial stress.

Rarely, some medicines or illicit drugs may cause broken heart syndrome, including:

• Emergency medicines used to treat very bad allergic reactions or asthma attacks.
• Some medicines used to treat attention-deficit/hyperactivity disorder (ADHD).
• Some medicines used to treat anxiety.
• Medicines used to treat a stuffy nose.
• Illicit drugs, such as methamphetamine and cocaine.

Always tell your healthcare team about the medicines you take. Include those you can buy without a prescription. When starting a new medicine, talk with your care team about the possible risks and side effects.

How is broken heart syndrome different from a heart attack?

A blockage or partial blockage in a heart artery causes a heart attack. In broken heart syndrome, the heart arteries are not blocked. But less blood may flow through the heart arteries.

Risk factors for broken heart syndrome include:

• Sex. Broken heart syndrome is more common in women than in men.
• Age. Most people who have broken heart syndrome are older than 50.
• Mental health conditions. People who have had or have anxiety or depression may have a higher risk of broken heart syndrome.

Most people who have broken heart syndrome get better quickly. They usually don't have long-lasting effects. But sometimes the condition comes back. When this happens, it is called recurrent takotsubo cardiomyopathy.

Possible complications of broken heart syndrome include:

• Backup of fluid into the lungs, called pulmonary edema.
• Low blood pressure.
• Irregular heartbeats, called arrhythmias.
• Heart failure.
• Blood clots in the heart.

Rarely, broken heart syndrome can cause death.

To help prevent broken heart syndrome, healthcare professionals may suggest beta blockers. These medicines help the heart by blocking the effects of stress hormones, which can hurt the heart if levels go too high.

Ongoing stress may increase the risk of broken heart syndrome. So it's important to take steps to manage emotional stress. Doing so can improve your heart health. It also may help prevent broken heart syndrome. Some ways to reduce or manage stress are:

• Get more exercise.
• Practice mindfulness.
• Connect with others in support groups.

Broken heart syndrome is often diagnosed in the emergency room or hospital because the symptoms can look a lot like a heart attack.

To find out if you have broken heart syndrome, a healthcare professional examines you. If you are stable, you are usually asked questions about your symptoms and medical history. You also may be asked if anything stressful has happened lately, such as the loss of a loved one or another big life event.

People who have broken heart syndrome usually don't have heart disease symptoms before the condition starts.

Tests

Tests to help diagnose broken heart syndrome include:

• Blood tests. People who have broken heart syndrome often have higher levels of proteins called cardiac enzymes in the blood. One example is troponin T, which is found in the heart muscle. A blood test can check for these proteins.
• Electrocardiogram (ECG or EKG). This quick test measures the electrical activity of the heart. Sticky patches called electrodes go on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which shows or prints the test results. An ECG shows how fast or how slow the heart is beating.
• Coronary angiogram. This test looks for blockages in the heart arteries. It's used to rule out a heart attack. People with broken heart syndrome usually do not have any significant blockages in their heart. To do the test, a doctor places a thin, soft tube called a catheter into a blood vessel, usually in the groin or wrist. The doctor then gently moves the tube toward the heart. A special dye goes through the tube into the heart's arteries. This dye helps the arteries show up clearly on X-ray images and video.

Once it's clear that you're not having a heart attack, your healthcare team checks to see if your symptoms are caused by broken heart syndrome.

• Echocardiogram. This test uses sound waves to create pictures of the beating heart. It shows how blood flows through the heart and heart valves. It can show if the heart is bigger than usual or has an unusual shape. These changes may be due to broken heart syndrome.
• Cardiac MRI. This test uses magnetic fields and radio waves to make detailed images of the heart.

There's no set treatment for broken heart syndrome. Healthcare professionals treat the symptoms like a heart attack until they know for sure what is going on. Most people need to stay in the hospital while they get better. Medicines are used to treat symptoms and any complications.

Many people with broken heart syndrome feel fully better in about a month. A test called an echocardiogram is done 4 to 6 weeks after the first symptoms. This test checks if the heart is working well again. Sometimes, broken heart syndrome comes back after treatment.

Medications

If you have broken heart syndrome, medicines are usually given to:

• Treat symptoms and complications.
• Take stress off the heart.
• Stop broken heart syndrome from happening again.

Medicines for broken heart syndrome may include:

• Angiotensin-converting enzyme (ACE) inhibitors.
• Angiotensin 2 receptor blockers (ARBs).
• Beta blockers.
• Water pills, also called diuretics.
• Blood thinners, if you have a blood clot.

Surgeries or other procedures

Surgeries and procedures used to treat a heart attack don't help treat broken heart syndrome. Those treatments open blocked arteries. Blocked arteries do not cause broken heart syndrome.

Broken heart syndrome is usually diagnosed in an emergency or a hospital setting.

If you can, bring a family member or friend with you to the hospital. Someone who goes with you can help you remember the information you're given.

If you can, share important information with the person who is taking you to the hospital. This can help your health team take better care of you. Be sure to tell them about:

• Any symptoms you're having, and how long you've had them.
• 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 health conditions such as diabetes, high cholesterol or heart disease.
• The medicines you take, including those bought without a prescription.
• Any recent injury to your chest that may have caused damage inside the body, such as a broken rib or pinched nerve.

At the hospital, you may have many questions. If possible, you may want to ask:

• What do you think is causing my symptoms?
• I recently had a loved one suddenly die. Could my symptoms be due to this event?
• What tests do I need?
• Do 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?
• How should I change my diet or activities?

Don't hesitate to ask any other questions.

What to expect from the doctor

A healthcare professional who sees you for chest pain may ask:

• What symptoms are you having?
• When did the symptoms start?
• Does your pain spread to any other parts of your body?
• Does your pain briefly get worse with each heartbeat?
• What words would you use to describe your pain?
• On a scale of 1 to 10, with 10 being the worst, how bad is your pain?
• Does exercise or physical activity make your symptoms worse?
• Do you have a family history of heart conditions?
• Are you being treated or have you recently been treated for any other health conditions?