Broken heart syndrome: can your heart really break?

 

The human body is made up numerous organs – each one as impressive as the next. So, why is it that the heart is most commonly associated with our emotions? According to a study, we experience certain bodily sensations, such as anger, fear, happiness, sadness, anxiety, love or pride in our chest area.^[1]

For all these varying emotions, society has developed different expressions relating to the heart: your heart might stop if you receive some bad news, or it might race if you’re nervous. Similarly, your heart could drop with disappointment, it could skip a beat if you catch someone’s eye – or after a break-up, you might experience heartache. Most of these expressions are universal and exist in multiple languages and cultures across the globe!

Common expressions aside, to what extent do our hearts play a role in our emotions? Is the heart as heavily impacted by stress and joy as we might think? Does ‘heartbreak’ go beyond its definition of ‘overwhelming distress’?^[2]

In our blog article, we get to the heart of the matter with broken heart syndrome: what causes this heart condition and what are other possible broken heart syndrome symptoms? What are the differences between this condition and a heart attack and how is it treated? Can you cure broken heart syndrome? Find out now!

Broken heart syndrome: Can you really suffer from a broken heart?

You can break your bones, but can a heart really break? Of course not – at least, not in a literal sense. You have no doubt already experienced first-hand how your heart reacts to certain emotions: whether it’s excitement, shock, joy, grief, anger or fear. In such instances, your heart behaves differently than normal. 

A significant emotional burden can cause the heart to tense up and literally paralyse it. As with a heart attack, this can lead to chest pain and difficulty breathing. This condition is called broken heart syndrome – alternatively, ‘takotsubo cardiomyopathy’, ‘takotsubo syndrome’ or ‘stress cardiomyopathy’.

Did you know that the term ‘takotsubo cardiomyopathy’ comes from the Japanese term ‘takotsubo’, a pot that is used to trap octopus?^[3] Experts designated this term to broken heart syndrome, as circulatory problems caused by the condition leave the top of the left heart chamber constricted and the bottom swollen like a balloon.

Broken heart syndrome is when the body releases stress hormones, such as adrenaline, noradrenaline and dopamine, into the blood on a large scale, overwhelming the wall of the heart. The heart tenses up and can no longer receive proper blood flow, leaving it almost paralysed. Those affected by this condition might notice symptoms similar to that of a heart attack, such as chest pain, sweating and breathing difficulties. If complications arise, such as cardiac arrhythmias or ventricular fibrillation, broken heart syndrome can become fatal.^[4]

Who is most prone to broken heart syndrome?

Broken heart syndrome was first recognised by Japanese doctors as a condition in its own right in the 1990s. Since then, the condition has been researched on a global scale. 

Experts estimate that between one and two per cent of people suffering from the symptoms of a heart attack are actually suffering from broken heart syndrome.^[5] Data up until now has indicated that it is predominantly women after menopause who are affected by this condition. Almost 90 per cent of those suffering from broken heart syndrome are women with an average age of 66 years old.^[6]

The reason for this could be a decrease in oestrogen levels. Oestrogen hormones in women have a protective function on the heart. After menopause, the concentration of oestrogen in the blood decreases. Women are then more susceptible to stress hormones – if an intensely stressful situation causes the body to secrete a significant number of stress hormones into the blood, the heart might subsequently be overwhelmed and circulation could be negatively affected.^[7]

Curious to find out more about the function of oestrogen in our bodies as we age? Head over to our blog article on oestrogen levels now!

Broken heart syndrome symptoms: what does broken heart syndrome feel like?

People with broken heart syndrome often experience the same symptoms that occur with a heart attack, for example:^[8]

•     Chest pain, tightness in the chest
•     Shortness of breath or breathing difficulties
•     Nausea and vomiting
•     Heart palpitations
•     Pain in the left arm that can be felt all the way up to the lower jawbone

Some people may also experience dizziness triggered by low blood pressure and sweating.

Can you survive broken heart syndrome?

Most people with broken heart syndrome symptoms will find that their heart function returns to normal after a few weeks without any harmful side effects. Recent data, however, reveals that around four per cent of people with the condition die from it.^[5]

Moreover, there may be subsequent long-term damage: according to a recent study, people are considerably more likely to suffer from a stroke within five years of broken heart syndrome than people who have suffered from a heart attack.^[9]

Some people may later experience heart failure or a heart attack.^[10] Roughly five per cent of those affected by broken heart syndrome experience a second episode within the following four years.^[5] This is why such people should receive medical assistance over an extended period following the emergence of this condition. Regular check-ups help to determine and prevent a relapse in your heart health.

What causes broken heart syndrome?

The exact causes of broken heart syndrome are still being determined today by experts, but the good thing is that we now know more and more about the condition and what could possibly trigger it, and these emerging insights are currently under investigation by scientists. 

Can emotional stress cause heart problems?

Today, experts believe that the main cause of broken heart syndrome lies in physical or psychological stress.^[11]

With this in mind, studies have revealed that men and women noticeably react more to various forms of stress.

Broken heart syndrome is mostly caused by physical stress (for example, caused by accidents or infections) in men; in women, conversely, the condition is caused more often by psychological stress (such as financial emergencies, domestic abuse or the death of a loved one).

It’s also interesting to note that when physical stress has caused broken heart syndrome, serious complications are far less likely to emerge.^[10]

Did you know that you can also put stress on your heart in joyful situations, such as weddings or winning the jackpot? This is called happy heart syndrome.^[12]

Is broken heart syndrome linked to genetics?

Most of us will experience stressful situations in our lifetimes, but only a few of us may react with broken heart syndrome. In addition to this, there are many known cases where multiple family members, often siblings or twins, that have experienced broken heart syndrome. Experts therefore suspect that the tendency to exhibit extreme reactions to stress could be passed down from one generation to the next. 

Genetics and our DNA are therefore now coming to the forefront of scientific research: a study of the genes of people with broken heart syndrome revealed abnormalities in gene segments that are also thought to be linked to the development of obesity, cancer and mental disorders.

Particularly striking were changes in genes responsible for blood pressure and thyroid levels.^[13] This seems to indicate a connection between the risk of broken heart syndrome and the risk of other illnesses.

The connection between cancers and broken heart syndrome is already being investigated by researchers. In one international study, it was revealed that every sixth person with broken heart syndrome also had cancer.^[14]

Experts hope that with such data, it will be easier to identify people with a statistically higher chance of experiencing broken heart syndrome. This way, preventive measures can be carried out in due time. These days, more readily available modern DNA tests are able to give us greater insights into our health.

How can I check my heart health at home?

How healthy is your heart? Your DNA will tell you if you are particularly prone to certain heart and circulation problems. Some heart health tests investigate various parameters that indicate the state of your cardiovascular health – this is particularly the case for various DNA heart health tests, which typically analyse gene variants of several genes in your saliva.

These gene variants provide indications of whether you are at risk of high cholesterol levels, oxidative stress, heart or blood vessel inflammation or high blood pressure. If you are aware of these risks, you can prevent them in a targeted manner and take steps to boost your heart and blood vessels’ health and vitality! 

Alternatively, you can opt to take a cholesterol test, the results of which will identify whether you need to take active measures to lower your LDL cholesterol levels to thereby reduce your risk of developing cardiovascular diseases. 

Diagnosis: how do you get a diagnosis for broken heart syndrome?

Those who experience broken heart syndrome symptoms confuse symptoms with those of a heart attack, such as breathing difficulties and chest pain. 

The first indications of broken heart syndrome include the significantly increased presence of stress hormones such as adrenaline, noradrenaline and cortisol. The critical clues that broken heart syndrome is the culprit rather than a heart attack are only possible to determine when doctors take a closer look at the heart.

Upon inspection by a cardiac catheter, it is clear that coronary arteries are not calcified – as would be the case with a heart attack. Blood can therefore flow normally. With an ultrasound of the heart, however, doctors will notice the left ventricle of your heart bulging. This is due to it receiving too little oxygen with the increased stress hormone levels. It becomes stiff and inflates like a balloon.^[15]

To read more about what cortisol does in our bodies – and how to improve your cortisol levels, read our dedicated Health Portal article. You might also want to check your cortisol levels as a preventive measure to ensure your heart and general mental health are optimal.

Broken heart syndrome treatment: what can I do?

Can broken heart syndrome be cured? As broken heart syndrome can sometimes lead to serious complications, those affected are often observed for 48 hours in A & E. They are also examined by a cardiologist at regular intervals afterwards to check their heart functions.^[16]

Which medications should be taken as broken heart syndrome treatment?

Doctors can prescribe various medications for the condition, including:^[8]

•       Beta blockers and ACE inhibitors: these protect the heart from the harmful effect of stress hormones and prevent cardiac arrhythmias.
•       Diuretic medications: increased urine output reduces blood volume and makes it easier for the heart to function.
•       Blood-thinning medications: for people at high risk of thrombosis and heart palpitations.

With these forms of broken heart syndrome treatment, the heart can recover within three months. Unlike a heart attack, there are often no scars and no persisting problems with heart muscles. However, new stressful situations can lead to relapses. This is why those affected should regularly have their heart checked by a doctor.

How to avoid broken heart syndrome

Experts recommend that people with broken heart syndrome avoid stress, where possible, and possibly attend psychotherapy sessions. There are also various supplements promoting mental balance that contain anxiety remedies such as as tryptophan and vitamin D.^[16] 

Did you know that during psychotherapy, you can learn coping strategies to help you combat stress and overwhelming emotions? Various relaxation techniques, such as breathing exercises and yoga, could also prove very helpful. Find out more about relaxation techniques and what emotional resilience means in our blog article.

Broken heart syndrome – at a glance

What is broken heart syndrome?

Broken heart syndrome is a sudden onset heart muscle disease triggered by severe stress. Women after menopause are particularly affected. People can completely recover from broken heart syndrome in most cases. In rarer cases, life-threatening complications may occur.

What are typical broken heart syndrome symptoms?

The symptoms of broken heart syndrome are similar to that of a heart attack. Such symptoms include, for example, chest pain, shortness of breath or breathing difficulties, nausea, dizziness, heart palpitations and pain in the left arm.

What causes broken heart syndrome?

Physical or psychological stress are the main causes of broken heart syndrome. Clustered cases within families have led experts to suspect that the risk of broken heart syndrome may be inherited. 

How does broken heart syndrome treatment work?

People with this condition have highly elevated stress hormone levels in their blood. The coronary vessels are not calcified, but a balloon-like bulging of the left ventricle is evident. 

Those affected are first placed under intensive medical supervision and receive various medications, such as beta blockers and blood-thinning agents. 

Following broken heart syndrome, regular check-ups on the heart’s recovery are normal. Experts recommend that those affected by the condition visit a psychotherapist. 

Sources

^[1] Nummenmaa L., Glerean E., Hari R., Hietanen J. K. ‘Bodily maps of emotions’ Proceedings of the National Academy of Sciences, vol. 111(2), 646–651, 2014. doi:10.1073/pnas.1321664111

^[2] ‘Definition of heartbreak’, Oxford Dictionaries, https://premium.oxforddictionaries.com/definition/english/heartbreak, accessed on 5 February 2021.

^[3] ‘Gebrochenes Herz - erste Hilfe in Sicht’, Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., 2 October 2017. https://dzhk.de/aktuelles/news/artikel/gebrochenes-herz-erste-hilfe-in-sicht/ [accessed 11 January 2021].

^[4] Lehnen-Beyel I., ‘Auch in Deutschland beschäftigen sich immer mehr Kardiologen mit dem Broken-Heart-Syndrom’, AerzteZeitung.de, 1 June 2006, https://www.aerztezeitung.de/Medizin/Auch-in-Deutschland-beschaeftigen-sich-immer-mehr-Kardiologen-mit-dem-Broken-Heart-Syndrom-384212.html [accessed 15 December 2020].

^[5] Ahmad S. A., Brito D., Khalid N., et al., ‘Takotsubo Cardiomyopathy’, in StatPearls, Treasure Island (FL): StatPearls Publishing, 2020. https://www.ncbi.nlm.nih.gov/books/NBK430798/

^[6] Templin C. et al., ‘Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy’, N Engl J Med, vol. 373(10), 929–938, 2015. doi: 10.1056/NEJMoa1406761.

^[7] Shufelt C. et al. ‘Sex-specific physiology and cardiovascular disease’, Adv Exp Med Biol, vol. 1065, 433–454, 2018. doi: 10.1007/978-3-319-77932-4_27.

^[8] ‘Takotsubo cardiomyopathy’, British Heart Foundation, January 2020, https://www.bhf.org.uk/informationsupport/conditions/cardiomyopathy/takotsubo-cardiomyopathy [accessed 11 January 2021].

^[9] El‐Battrawy I. et al. ‘Short‐term and long‐term incidence of stroke in Takotsubo syndrome’, ESC Heart Fail, vol. 5(6), 1191–1194, 2018, doi: 10.1002/ehf2.12357.

^[10] Giannakopoulos K. et al., ‘Comparison and Outcome Analysis of Patients with Takotsubo Cardiomyopathy Triggered by Emotional Stress or Physical Stress’, Front Psychol., vol. 8, 2017. doi: 10.3389/fpsyg.2017.00527.

^[11] Universitätsspital Zürich, ‘What is Takotsubo Cardiomyopathy?’, TakoTsubo International Registry. https://www.takotsubo-registry.com/about-takotsubo.html [accessed 12 January 2021].

^[12] Ghadri J. R. et al., ‘Happy heart syndrome: role of positive emotional stress in takotsubo syndrome’, European Heart Journal, vol. 37(37), 2823–2829, 2016. doi: 10.1093/eurheartj/ehv757.

^[13] ‘Stress-Kardiomyopathie: “Broken Heart Syndrome” könnte genetische Ursachen haben’, Deutsche Gesellschaft für Kardiologie – Herz und Kreislaufforschung e.V. (DGK), 20 April 2017 [online], https://dgk.org/daten/1-Eitel-Tako-Tsubo.pdf [accessed 12 January 2021]

^[14] Cammann V. L. et al., ‘Clinical Features and Outcomes of Patients With Malignancy and Takotsubo Syndrome: Observations From the International Takotsubo Registry’, J Am Heart Assoc., vol. 8(15), e010881, 2019. doi: 10.1161/JAHA.118.010881

^[15] Schmidt J., ‘Broken-Heart-Syndrom mit kardiogenem Schock erhöht das Sterberisiko auch langfristig’, Kardiologie.org - Referenz für medizinische Fachinformationen in der Herzkreislaufmedizin, 27 November 2018. https://www.kardiologie.org/aha-kongress-2018/broken-heart-syndrom-mit-kardiogenem-schock-erhoeht-das-sterberi/16297238 [accessed 13 January 2021]

^[16] Erbe B., ‘Broken-Heart-Syndrom: Herz in der Zwickmühle’, Pharmazeutische Zeitung online, 30 June 2020, https://ptaforum.pharmazeutische-zeitung.de/herz-in-der-zwickmuehle-118239/seite/alle/ [accessed 13 January 2021]

^[17] Santoro F. et al., ‘Assessment of the German and Italian Stress Cardiomyopathy Score for Risk Stratification for In-hospital Complications in Patients With Takotsubo Syndrome’, JAMA Cardiology, vol. 4(9), 892–899, 2019. doi: 10.1001/jamacardio.2019.2597.