When Your Heart Breaks - Stressed-Induced Cardiomyopathy

Though the phrase “broken heart,” is most often used to describe those who have suffered a devastating emotional, often romantic, loss, there is indeed a clinical diagnosis referred to as “broken-heart syndrome.”

This broken-heart syndrome occurs in only about 1.7% of all instances of acute coronary syndrome, a group of conditions that also includes heart attacks (myocardial infarction) and unstable anginas. Despite its rarity, this condition goes by a surprising number of names:

stress-induced cardiomyopathy
stress cardiomyopathy
apical ballooning syndrome
takotsubo cardiomyopathy.

From these many names we can learn two important things about broken heart syndrome.

1. “Broken-heart syndrome” and “stress-induced cardiomyopathy” are accurate descriptors of the circumstances which bring on such an event. Researchers have found links between mental health and heart disease. Our mental and emotional well-being is linked to our physical health. Over 85% of instances of broken-heart syndrome take place after a physically or emotionally traumatic event. Events include, but are not limited to:

domestic violence
severe pain
asthma attacks
loss of a loved one
financial loss
extreme fear

2. “Apical ballooning syndrome” and “takotsubo cardiomyopathy” describe the shape of the heart’s muscular wall during this event. Normally, the heart muscle has a uniform thickness, and the shape of the heart tapers to a point near the base. During this cardiomyopathic event, the muscle wall of left ventricle of the heart—the primary pumping chamber—thins and balloons out toward the apex. Since the initial research into this syndrome took place in Japan in the early 1990s, the researchers there dubbed the abnormality Takotsubo cardiomyopathy, in reference to a traditional octopus fishing trap of roughly the same shape.

Causes:

The vast majority (up to 90%) of stress-induced cardiomyopathy cases occur in menopausal women. In fact, it’s estimated that up to 5% of heart attack cases in women are actually from this condition.

The means by which stress causes this condition are not fully understood yet. The current medical opinion is that the stress hormone, adrenaline, interferes with the function of the heart’s left ventricle, causing it to spasm, rather than pump, which leads to the ballooning. Doctors believe that lowered estrogen levels in women who have undergone menopause makes them especially susceptible to this event.

Symptoms:

The biggest symptoms in someone who experiences stress-induced cardiomyopathy are extreme chest pain and shortness of breath. Further tests are needed to conclusively rule out a heart attack.

Unlike in a heart attack, the patient will not have any blockages in their coronary arteries, will not have markers for heart damage in their blood tests, will have an EKG pattern distinct from that of a heart attack patient, and will have a balloon-shaped ventricle in heart imaging.

Treatment:

The mortality rate of broken-heart syndrome is quite low, and most patients make a full recovery within a few days or weeks, rarely lasting as long as two months. Additionally, patients are at a low risk of experiencing a second stress-induced cardiomyopathy event.

It is treated with ACE inhibitors, diuretics, and drugs to help strengthen the heart muscle, and aspirin if the patient has any plaque on the arterial wall. During and after recovery, the patient may also receive counseling to help them lower their stress levels and deal with any future events that may prove stressful.