Broken Heart Syndrome

Shocking news, such as learning of the unexpected death of a loved one, has been known to cause catastrophic events, such as a heart attack. Now, researchers have discovered that sudden emotional stress can also result in severe but reversible heart muscle weakness that mimics a classic heart attack. Patients with this condition called “Stress Cardiomyopathy” also known as “Broken Heart Syndrome” is often misdiagnosed with massive heart attack when actually they have been suffering from a surge in adrenaline (epinephrine) and other stress hormones. Broken Heart Syndrome has been written about for many years in Japan (where it is called "octopus trap cardiomyopathy" because of the peculiar shape of the ballooning heart muscle), but until relatively recently it has been poorly recognized in the rest of the world.

Patients with stress cardiomyopathy can have similar symptoms to patients with a heart attack including chest pain, shortness of breath, low blood pressure and congestive heart failure. Typically, these symptoms begin just minutes to hours after the person has been exposed to a severe, and usually unexpected, stress. It can be life threatening in some cases because the syndrome involves severe heart muscle weakness, patients can have congestive heart failure, low blood pressure, shock, and potentially life-threatening heart rhythm abnormalities, but if patients are under the care of physicians familiar with this syndrome, even the most critically ill tend to make a quick and complete recovery.

The human body produces various hormones and proteins such as adrenaline and nor-adrenaline which are meant to help cope with the stress. For example, if a person is suddenly threatened and fears physical harm, the body produces large amounts of adrenaline to help that person either defend himself/herself or run faster to escape the danger. With stress cardiomyopathy, we believe that the heart muscle is overwhelmed by a massive amount of adrenaline that is suddenly produced in response to stress. The precise way in which adrenaline affects the heart is unknown. It may cause narrowing of the arteries that supply the heart with blood, causing a temporary decrease in blood flow to the heart. Alternatively, the adrenaline may bind to the heart cells directly causing large amounts of calcium to enter the cells which render them temporarily. Whichever the mechanism, it appears that the effects of adrenaline on the heart in this syndrome are temporary and completely reversible.

Stress cardiomyopathy can easily be mistaken for heart attack but with a closer look, there are some major differences between the two conditions. First, most heart attacks occur due to blockages and blood clots forming in the coronary arteries (the arteries that supply the heart with blood). If these clots cut off the blood supply to the heart for a long enough period of time, heart muscle cells can die, leaving the heart with permanent and irreversible damage. This is completely different from what is seen with stress cardiomyopathy. Most of the patients with stress cardiomyopathy appear to have fairly normal coronary arteries and do not have severe blockages or clots. Secondly, the heart cells of patients with stress cardiomyopathy are “stunned” by the adrenaline and other stress hormones but not killed as they are in heart attack. Fortunately, this stunning gets better very quickly, often within just a few days. So even though a person with stress cardiomyopathy can have severe heart muscle weakness at the time of admission to the hospital, the heart completely recovers within a couple of weeks in most cases and there is no permanent damage.

Stress cardiomyopathy affects primarily women, in addition, it tends to occur most frequently in middle aged or elderly women (average age about 60). While it can also occur in young women and even in men, the vast majority of the patients are post-menopausal women. The exact reason for this is unknown, and further research will be necessary to help explain this observation. Stress cardiomyopathy appears to be a condition that comes on suddenly and unexpectedly and resolves quite quickly. If you are a person who frequently has symptoms of chest pain or shortness of breath when under significant stress, you should be evaluated by your doctor. He or she may want to perform some basic tests to make sure you are in good health. It is unlikely, however, if your symptoms have been going on for a while that you have stress cardiomyopathy.

As the heart muscle is not permanently damaged with this syndrome, patients typically make a rapid and complete recovery. From what has been published in different medical journals, the long-term prognosis for patients with stress cardiomyopathy appears to be excellent.