Introduction

Broken heart syndrome, also known as Takotsubo cardiomyopathy, is a temporary heart condition caused by sudden and extreme stress.

Extremely stressful events or serious physical illness can cause the heart muscle to suddenly weaken. This temporarily prevents the heart from pumping blood normally.

The symptoms of broken heart syndrome often mimic those of a heart attack – sudden severe chest pain and breathlessness. Fortunately, broken heart syndrome is reversible, and most people are expected to make a full recovery.

What is Broken Heart Syndrome?

Broken heart syndrome causes the left ventricle of the heart to weaken and change its shape. This prevents the left ventricle from doing its job of pumping blood around the body.

Broken heart syndrome is caused by intense stress. Potential triggers of broken heart syndrome include:

• The death of a loved one
• Receiving bad news
• Job loss or financial difficulty
• Divorce
• Domestic abuse
• Strong arguments
• Severe pain
• Health issues (e.g. asthma attack, seizure, stroke, high fever, large blood loss, low blood sugar)
• Major surgery

The exact cause of why stress causes broken heart syndrome is unknown. However, experts think that having excess stress hormones (catecholamines) temporarily stuns the heart muscle.

The name “takotsubo” comes from the Japanese word takotsubo “octopus trap”, because the left ventricle of the heart takes on a shape resembling an octopus trap when affected by this condition.

Can you die from a Broken Heart?

Although you can die from a broken heart, it is extremely rare and unlikely to happen. The risk of death from broken heart syndrome is approximately 1%.

In most cases, broken heart syndrome is temporary and reversible. Most people make a complete recovery after a few days or weeks.

What are the symptoms of Broken Heart Syndrome?

Symptoms of broken heart syndrome are similar to a heart attack, including:

• Chest pain
• Shortness of breath
• Sweating
• Palpitations

Symptoms can start anywhere from minutes to a few hours after a stressful event.

What are the complications of Broken Heart Syndrome?

Although broken heart syndrome is reversible, a small number of people may go on to develop complications. These include:

• Fluid in lungs (pulmonary oedema)
• Low blood pressure
• Heart failure
• Abnormal heart rhythm (arrhythmia)
• Stroke

The good news is that these complications are rare and are usually treatable.

How can you tell the difference between a Heart Attack and Broken Heart Syndrome?

Heart attacks are caused by blockages in the arteries that supply the heart (coronary arteries). This causes permanent damage to the heart muscle.

In broken heart syndrome, the heart muscle is not permanently damaged and the coronary arteries are not blocked. Instead, the left ventricle of the heart changes shape and weakens.

Specific cardiac investigations can be used to help determine the cause of chest pain, including:

Echocardiogram

• Broken heart syndrome: appearance of an abnormal balloon-shape left ventricle
• Heart attack: parts of the heart muscle weakened and damaged by the blocked artery will move abnormally

Coronary angiogram

• Broken heart syndrome: no critical blockages seen in coronary arteries
• Heart attack: coronary artery blockage can be detected

Left ventriculogram

How long can Broken Heart Syndrome last?

Broken heart syndrome is a temporary condition and usually reverses itself after a few days or weeks.

Most patients achieve full recovery within two months and are unlikely to suffer from long-term heart problems.

How is Broken Heart Syndrome treated?

There is no specific treatment for broken heart syndrome as the condition usually reverses itself. Treatment is generally supportive to manage symptoms and treat complications. These include:

1. Medications to treat heart failure and poor heart function

• ACE inhibitors/ angiotensin receptor blockers and beta-blockers to reduce strain on the heart
• Diuretics (water pills) to reduce fluid accumulation in the lungs
• Anticoagulation (blood thinners) to prevent blood clots in the heart chambers

2. Treatment of low blood pressure (cardiogenic shock)

• Inotropes (blood pressure supporting medications) or mechanical device support (intra-aortic balloon pump, mechanical circulatory support devices).

After the acute phase of the illness and when the patient is recovering, cardiac rehabilitation is important to build up physical strength. Stress management and heart-healthy lifestyle changes are also critical to the patient’s recovery.

Can Broken Heart Syndrome be prevented?

The best way to prevent broken heart syndrome is to manage stress. Try engaging in stress relaxation techniques, such as:

• Deep breathing exercises
• Mindfulness exercises
• Yoga, meditation
• Engaging in hobbies you like
• Writing down your thoughts and feelings
• Relaxing activities you enjoy
• Soaking in a warm bath

Summary

Our emotional wellness can affect our physical condition. Broken heart syndrome is a temporary and reversible heart condition that is caused by sudden extreme stress. The main symptoms of broken heart syndrome are chest pain and breathlessness, which mimics a heart attack.

If you suspect you may have broken heart syndrome, please seek medical attention immediately. Your cardiologist can assess with specific tests to rule out life-threatening causes of chest pain such as a heart attack, and manage complications arising from broken heart