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. It may also be called stress cardiomyopathy, takotsubo cardiomyopathy or apical ballooning syndrome.

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 your heart's normal pumping function. The rest of the heart continues to function normally or may even have more forceful contractions.

The symptoms of broken heart syndrome are treatable, and the condition usually reverses itself in days or weeks.

Symptoms

Broken heart syndrome symptoms can mimic a heart attack. Common symptoms 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 if you experience 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 constriction of the large or small arteries of the heart has been suspected to play a role. People who have broken heart syndrome may also have a difference in the structure of the heart muscle.

Broken heart syndrome is often preceded by an intense physical or emotional event. Some potential triggers of broken heart syndrome are:

• The death of a loved one
• A frightening medical diagnosis
• Domestic abuse
• Losing — or even winning — a lot of money
• Strong arguments
• A surprise party
• Public speaking
• Job loss or financial difficulty
• Divorce
• Physical stressors, such as an asthma attack, COVID-19 infection, a broken bone or major surgery

It's also possible that some drugs, rarely, may cause broken heart syndrome by causing a surge of stress hormones. Drugs that may contribute to broken heart syndrome include:

• Epinephrine (EpiPen, EpiPen Jr.), which is used to treat severe allergic reactions or a severe asthma attack
• Duloxetine (Cymbalta), a medication given to treat nerve problems in people with diabetes, or as a treatment for depression
• Venlafaxine (Effexor XR), a treatment for depression
• Levothyroxine (Synthroid, Levoxyl), a drug given to people whose thyroid glands don't work properly
• Unprescribed or illegal stimulants, such as methamphetamine and cocaine

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. This blockage is due to a blood clot forming at the site of narrowing from fatty buildup (atherosclerosis) in the wall of the 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

There are a number of known risk factors for broken heart syndrome, including:

• Sex. The condition affects women far more often than men.
• Age. It appears that most people who have broken heart syndrome are older than 50.
• A history of a neurological condition. People who have neurological disorders, such as a head injury or a seizure disorder (epilepsy) have a greater risk of broken heart syndrome.
• A previous or current psychiatric disorder. If you've had disorders, such as anxiety or depression, you probably have a higher risk of broken heart syndrome.

Complications

In rare cases, broken heart syndrome is fatal. However, most people who experience broken heart syndrome quickly recover and don't have long-lasting effects.

Other complications of broken heart syndrome include:

• Backup of fluid into your lungs (pulmonary edema)
• Low blood pressure (hypotension)
• Disruptions in your heartbeat
• Heart failure

It's also possible that you may have broken heart syndrome again if you have another stressful event. However, the odds of this happening are low.

Prevention

Broken heart syndrome sometimes happens again, though most people won't experience a second event. Many doctors recommend long-term treatment with beta blockers or similar medications that block the potentially damaging effects of stress hormones on the heart. Recognizing and managing stress in your life also may help prevent broken heart syndrome, though there's currently no evidence to prove this.

Diagnosis

If your doctor suspects you have broken heart syndrome, he or she will use these exams and tests to make a diagnosis:

• Personal history and physical exam. In addition to a standard physical exam, your doctor will want to know about your medical history, especially whether you've ever had heart disease symptoms. People who have broken heart syndrome usually don't have any heart disease symptoms before they're diagnosed with broken heart syndrome. Also, your doctor will want to know if you've experienced any major stresses recently, such as the death of a loved one.
• Electrocardiogram (ECG). In this noninvasive test, a technician will place wires on your chest that record the electrical impulses that make your heart beat. An ECG records these electrical signals and can help your doctor detect irregularities in your heart's rhythm and structure.
• Echocardiogram. Your doctor may also order an echocardiogram to see if your heart is enlarged or has an abnormal shape, a sign of broken heart syndrome. This noninvasive exam, which includes an ultrasound of your chest, shows detailed images of your heart's structure and function.
• Blood tests. People who have broken heart syndrome often have higher amounts of substances called cardiac enzymes in the blood.
• Cardiac magnetic resonance imaging (MRI). For this test, you lie on a table inside a long tube-like machine that produces a magnetic field. The magnetic field produces detailed pictures to help your doctor evaluate your heart.

• Coronary angiogram. During a coronary angiogram, a type of dye that's visible by X-ray machine is injected into the blood vessels of your heart. Then, an X-ray machine rapidly takes a series of images (angiograms) that give your doctor a detailed look at the inside of your blood vessels.

  Because broken heart syndrome often mimics the signs and symptoms of a heart attack, a coronary angiogram is often 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 is visible on an angiogram. Once it's clear that you're not having a heart attack, your doctor will check to see if your signs and symptoms were caused by broken heart syndrome.

Treatment

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

Once it's clear that broken heart syndrome is the cause of your symptoms, your doctor will likely prescribe heart medications for you to take while you're in the hospital, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, beta blockers or diuretics. These medications help reduce the workload on your heart while you recover and may help prevent further attacks.

Many patients make a full recovery within a month or so. You'll likely need to have another echocardiogram around four to six weeks after you first had symptoms to be sure your heart has recovered. Ask your doctor how long you will need to continue taking these medications once you recover, as most can be stopped within three months.

Procedures that are often used to treat a heart attack, such as balloon angioplasty and stent placement, or even surgery, aren't helpful in treating broken heart syndrome. These procedures treat blocked arteries, which are not the cause of broken heart syndrome. But, coronary angiography can be used to diagnose the cause of the chest pain.

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 a heart attack.

Call 911 or emergency medical help or have someone drive you to an emergency room if you experience new or unexplained chest pain or pressure that lasts for more than a few moments. Don't waste any time for fear of embarrassment if it's not a heart attack. Even if there's another cause for your chest pain, you need to be seen right away.

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

Share this information on the way to the hospital:

• Any symptoms you're experiencing, 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 problems that you or your close relatives have had, such as diabetes, high cholesterol or heart disease. It's also helpful for your doctor to know about any prescription and over-the-counter medications you're taking.
• Any recent trauma to your chest that may have caused an internal injury, such as a broken rib or pinched nerve.

Once you're at the hospital, it's likely that your medical evaluation will move ahead rapidly. Based on results from an electrocardiogram (ECG) and blood tests, your doctor may be able to quickly determine if you are having a heart attack — or give you another explanation for your symptoms. You'll probably have a number of questions at this point. If you haven't received the following information, you may want to ask:

• What do you think is causing my symptoms?
• Could my symptoms be due to the sudden unexpected death of my partner, as I've never had any symptoms like this before?
• 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?
• Should I see a specialist after returning home?

Don't hesitate to ask any additional questions that occur to you during your medical evaluation.

What to expect from the doctor

A doctor who sees you for chest pain may ask:

• What symptoms are you having?
• When did these symptoms begin?
• Does your pain radiate to any other parts of your body?
• Does your pain momentarily increase with each heartbeat?
• What words would you use to describe your pain?
• Does exercise or physical exertion make your symptoms worse?
• Are you aware of any history of heart problems in your family?
• Are you being treated or have you recently been treated for any other health conditions?
• Have you ever been diagnosed with gastroesophageal reflux disease (GERD)?