Introduction

BROKEN HEART SYNDROME was initially called Takotsubo cardiomyopathy. It is also called stress-induced cardiomyopathy as it is known to develop due to intense emotional or physical stress. It is an acute condition where there is rapid weakening of the cardiac muscles due to stressors.

Stress-induced cardiomyopathy is commonly described as a physical pain in the heart or area around the chest resulting from a surge in stress hormones. This can be due triggered by an emotionally stressful event such as the demise of a loved one.

Weakness in the heart muscle interferes with the ability to pump and supply blood efficiently. Cells in the body need sufficient supply of oxygen carried by blood in order to perform normal functions.

Synonyms

What are the other names for broken heart syndrome?

Apart from Takotsubo Cardiomyopathy and stress-induced cardiomyopathy, other names for broken heart syndrome are:

• Gebrochenes-Herz syndrome.
• Apical ballooning cardiomyopathy.

The term “Takotsubo” is Japanese and it means an octopus trap. This refers to the abnormal ballooning of the shape of the heart.

Key Facts & Statistics

Key facts and statistics that surround broken heart syndrome

• This condition affects about 15-30 persons per 100,000 per year, in accordance with a study conducted in 2018.
• Nearly 9 out of 100 cases of broken heart syndrome lead to death. However, it is a temporary condition for most of the people and recovery occurs within several months.
• A study conducted in 2020 revealed that physical triggers are the most common cause of broken heart syndrome.
• Takotsubo cardiomyopathy occurs in 2 out of 100 persons that visit a clinician for a suspected heart attack. It is speculated that the exact figure might be higher since the clinicians may fail to recognize the condition.
• Women make up almost 90% of all reported cases, and the chances increase post-menopause.

Risk Factors

What are the risk factors for broken heart syndrome?

Risk factors for stress-induced cardiomyopathy are:

• Sex. Being assigned female at birth (AFAB).
• Age. Being above 50 years old.
• Psychiatric disorders, such as anxiety.
• Neurological disorders such as seizures.

Triggers & Causes

What are the causes and triggers of broken heart syndrome?

Physical elements that are likely to trigger broken heart syndrome are:

• Long-term health conditions that contribute to physical stress such as depression.
• Microvascular illness that affect the vessels that carry blood.
• Occurrences that lead to adrenaline rush such as trauma and asthma attacks.
• Hormonal alterations.
• Genetic conditions.
• Psychiatric conditions such as anxiety disorder.

The exact causes of Takotsubo cardiomyopathy are not yet established. However, researchers link stressful situations and events to this condition. Examples include loss of a job, death of a loved one or divorce.

The body releases stress hormones into blood when we react to stressful situations. It is thought that these hormones interfere temporarily with the ability of the heart to function efficiently.

Emotional stressors linked to broken heart syndrome are:

• Traumatic occurences such as natural disasters like earthquakes.
• Intense fear.
• Grief due to loss of a family member, a friend, money or property.
• Bad news.

Physical stressors linked to broken heart syndrome are:

• Extreme pain.
• Health and medical concerns such as asthma attacks, seizure, stroke and excessive blood loss.
• Exhaustion from physical activities.

Signs & Symptoms

What are the signs and symptoms of broken heart syndrome?

• Signs and symptoms of broken heart syndrome present within minutes up to hours after a stressful circumstance.
• Manifestations similar to heart attack are produced (when the cardiac muscles are temporarily stunned by release of stress hormones).
• The following are common signs and symptoms of broken heart syndrome:

1. Angina.
2. Dyspnoea.
3. Weakened left ventricular muscles.
4. Hypotension.
5. Fainting.
6. Arrhythmias.

Note that unlike heart attack, broken heart syndrome does not present with blockage of coronary arteries nor permanent heart damage. Additionally, the recovery occurs faster and completely.

Types

What are the most common types of broken heart syndrome?

There are 4 different kinds, and these are: apical, mid-ventricular, basal and focal broken heart syndrome.

• Apical broken heart syndrome is the most common kind and accounts for more than 80% of cases. The lower half of the heart gets affected.
• Mid-ventricular broken heart syndrome affects the middle part of the ventricles.
• Basal broken heart syndrome is very rare, accounting for about 2 out of 100 cases.
• Focal broken heart syndrome is the rarest form. It accounts for approximately 1% of cases and affects a much smaller area as compared to other kinds.

Diagnostic Procedures & Tests

How is broken heart syndrome diagnosed?

• Patient-history taking and review.
• Performing a physical examination.
• Conducting tests such as :

1. Blood tests. Persons with Takotsubo cardiomyopathy often have raised levels of cardiac enzymes within their blood.
2. Electrocardiogram. It measures the electrical activity of the heart.
3. Coronary angiography. It is used to check for any blockages within the arteries of the heart. It is used to rule out heart attack. In broken heart syndrome, the arteries are not blocked unlike in heart attack.
4. Echocardiography. It utilizes sound waves to create images of the beating heart.
5. Chest X-ray. A chest X-ray can show if the heart is an unusual size or shape. It can help confirm a valve disorder or diagnose heart failure
6. Heart MRI. It is also called a cardiac MRI. It uses radio waves and magnetic fields to create detailed images of the heart.
7. Ventriculogram. A dye is injected into the left ventricle then X-ray images are taken to show the size of this ventricle and its pumping efficiency.

Treatment and Management

Does broken heart syndrome have a cure?

No. Currently, there is no known cure for broken heart syndrome. However, recovery is possible after taking medications.

How is broken heart syndrome treated?

• Aspirin. It prevents formation of blood clots within the vessels and improves blood flow.
• Angiotensin-converting enzyme inhibitors (ACEIs) such as enalapril and angiotensin-receptor blockers such as losartan. These agents are used in lowering blood pressure.
• Diuretic agents that decrease fluid in the body.
• Beta-blocker medications that slow the heart rate.
• Blood thinners can be used in case of blood clots.

Complications

What are the complications of broken heart syndrome?

The following are complications of broken heart syndrome. However, they occur rarely:

• Low blood pressure, otherwise referred to as hypotension.
• Pulmonary edema.
• Arrhythmia. This refers alterations in the normal rhythm of the heart.
• Cardiogenic shock. Dysfunction of the heart causes blood flow to drop suddenly.
• Heart failure. It is a permanent reduction in the function of the cardiac (heart) muscles.
• Heart block.
• Death.

Prevention

How do we prevent broken heart syndrome?

There are not yet established methods for prevention of broken heart syndrome. However, managing stress early can help to limit the burden of physical and emotional stress.

Some of the strategies to be employed as mechanisms for coping with stress are:

• Practicing meditation and mindfulness.
• Journal. Write down your thoughts and evaluate them one after another.
• Take in long, deep breaths and breathe out slowly.

Additional healthy habits that can be employed for managing stress are:

• Perform regular physical exercise.
• Embrace healthy diets such as the Mediterranean diet.
• Have a good sleep hygiene.
• Avoiding using tobacco products and other forms of recreational drugs.