Emotional Health · Health

Broken Heart Syndrome

Can you really die of a broken heart?

In medical circles, there’s a famous story of a couple on a farm who were married for 50 years. Each afternoon the husband worked in the fields and each evening at dinnertime, his wife would go out on the porch to ring a bell alerting him that dinner was ready. One evening, when the wife went to the porch, she saw her husband lying dead in the field. She clutched her chest and in that moment she too dropped dead.

This syndrome, now known as “broken heart syndrome” is an increasingly recognized phenomenon. It was initially described in the 1990s in Japan, where it was dubbed tako-tsubo syndrome, because the heart takes on the appearance of a traditional octopus trap, or tako-tsubo—an egg-shaped container that allows an octopus to crawl in but not out.

Under circumstances of extreme emotional stress, or less commonly physical trauma, a surge of adrenalin “stuns” the heart, rendering it nearly incapable of pumping. In that moment sudden death can occur, but if it does not, the symptoms resemble that of a heart attack. Most commonly, a person will experience chest pain, tightness, or heaviness, often associated with difficulty breathing. Less commonly, they will feel profoundly fatigued, become sweaty or experience light-headedness. Symptoms are rarely subtle.

In a heart attack, a blockage occurs in an artery supplying the heart with blood. The region of the heart affected is also initially stunned. If blood flow is not quickly restored, this heart muscle will die, scar, and never contract again. In people with “broken heart syndrome,” though, no arteries are blocked and the heart is globally affected. (At right, a schematic representation of takotsubo cardiomyopathy compared to a normal heart).

Sometimes a heart becomes so weak that intensive care intervention is needed to support the blood pressure. Unlike a heart attack, however, very little or no heart damage occurs. If the heart can be supported, most patients make a full recovery with no detectable trace of the incident, sometimes in as short a time as two to three days but almost always within a few weeks.

The syndrome is relatively rare, accounting for fewer than 1 percent of people initially diagnosed with a heart attack. It can be triggered by witnessing the death of a loved one, as in the couple described above, by a break-up with a lover, after an emotional argument, or even after being startled by a surprise party.

Although it has been seen in younger women and in men, for reasons that aren’t completely understood, this syndrome most commonly occurs in post-menopausal women. There are no known predisposing risk factors for developing broken heart syndrome. Researchers are studying genetics, but to date we remain in the dark.

So for post-menopausal women in particular, it’s important to know about this syndrome, to be aware of the symptoms and especially the circumstances that could trigger it, and to bring those circumstances to your doctor’s attention if need be. Broken heart syndrome is treated differently than a heart attack, so it’s also important for emergency room doctors and cardiologists to be familiar with it, and to determine whether broken heart syndrome is a factor in a patient’s condition. Understanding its good prognosis—and that with proper support for the heart, full recovery is the usual outcome—is important and beneficial for patients and families alike.

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