Of all the times I’ve suffered the emotional pain of romantic failure, it has been a comfort knowing I couldn’t die from a broken heart. But, as it turns out, the pain of losing a loved one can cause physical symptoms, much like a heart attack, that can be life threatening. It’s called broken heart syndrome, and I asked Connie Keibler, ARNP, of the Heart Institute at Virginia Mason, to answer a few questions about the condition.
What is broken heart syndrome? Is it the same as a heart attack?
Keibler: Broken heart syndrome feels like a heart attack and causes temporary, reversible heart failure. Although the symptoms are similar to a heart attack, patients do not have obstructive coronary artery disease, and they do not have permanent heart damage. In fact, this condition reverses in just a couple weeks or months. However, broken heart syndrome can be fatal, causing severe heart failure, low blood pressure, cardiogenic shock, and life threatening heart rhythm abnormalities or arrhythmias.
Why is it called broken heart syndrome?
Keibler: The condition usually follows intense emotional or physical stress, and symptoms typically begin minutes to hours after someone is exposed to severe, unexpected stress. It is believed the heart muscle is overwhelmed by a massive amount of stress hormones, adrenaline and epinephrine, that result from exposure and response to the stressor. Broken heart syndrome is known by other names: stress cardiomyopathy, stress-induced cardiomyopathy, apical ballooning syndrome and Takotsubo cardiomyopathy.
Why does it happen?
Keibler: Science is attempting to understand the exact pathophysiological process. Preceding clinical stressors have been identified as a sudden illness, asthma attack, death of a loved one, fear or anger. Patients who present with broken heart syndrome have symptoms and clinical findings that mimic a heart attack or myocardial infarction. They complain of chest pain, shortness of breath, have symptoms of congestive heart failure, and often have very low blood pressure. Clinically there will be EKG changes suggesting an acute coronary syndrome. When the patient is taken for a coronary angiography, the coronary arteries are found to be free of disease, but there is severe heart muscle weakness (cardiomyopathy).
Is it similar to a panic attack?
Keibler: No, it really is not. A panic attack causes similar physiologic symptoms experienced with a response to a perceived stress. Panic attacks do not cause the physical damage to the heart muscle, as we see in broken heart syndrome or stress cardiomyopathy.
Who is at risk? Can anyone get broken heart syndrome?
Keibler: Broken heart syndrome is diagnosed in 1.7 to 2.2 percent of patients presenting with acute coronary syndrome. It is very difficult to predict risk. We know that most patients do not have a previous history of heart disease, and we know that it primarily affects women. The average age is 60, and the vast majority of patients are post-menopausal women. This syndrome has been observed in young women and men, but is far less common.
Why do more women than men experience broken heart syndrome?
Keibler: We really do not know. Further research will be necessary to help explain this phenomenon.
How do you prevent it?
Keibler: It is difficult to predict who is at risk. Therefore it is difficult to prevent this rare condition. Once discovered or experienced, there is a chance of recurrence. It is recommended that patients stay on long-term treatment with beta blockers or similar medications to help prevent the damaging effects of stress hormones. It seems imperative that we all should strive to manage stress in our lives. Many stressors are not avoidable, but we can grow in our ability to respond to stress in healthier ways.
What should you do if you think you’re experiencing broken heart syndrome?
Keibler: You should seek medical attention immediately. Call 911 and get to an emergency room. It is reassuring that this condition is reversible, but it can be life threatening. Patients will require hemodynamic support and medical management, along with monitoring and treatment of arrhythmias during the acute phase. After recovery, the long term prognosis is excellent.