How Stress Can Break Your HeartLiterally
Broken heart syndrome can look and feel like a heart attack
Dr. Ilan Wittstein, MD, a cardiologist at Johns Hopkins Hospital, in Baltimore, once had a middle-aged patient who discovered that her husband was cheating on her. Shortly after a heated argument over the infidelity, the woman began to experience shortness of breath and a crushing chest pain. Although it felt like a heart attack, it wasnt. Quite literally, the woman was suffering from a broken heart.
Officially known as takotsubo cardiomyopathy, broken heart syndrome is a rare heart condition with symptoms that can mimic those of a heart attack.
“A lot of people experiencing the death of a loved one have this condition,” says Dr. Wittstein. “Thats why we nicknamed this broken heart syndrome.”
First described in Japanese medical literature in 1990, takotsubo cardiomyopathy takes its name from a vase-shaped pot, used to trap octopus in Japan, “that has a thin neck and balloons out where the body of the octopus gets stuck,” explains cardiologist Richard Stein, MD, a professor at the New York University School of Medicine, in New York City.
In broken heart syndrome, the bottom of the heart temporarily balloons out and resembles the shape of the traps, says Dr. Stein, who is also a spokesman for the American Heart Association.
Broken heart syndrome is most common among women (especially white women who have gone through menopause), and people who have depression or anxiety.
Though broken heart syndrome remains relatively rare, the number of people experiencing it appears to be on the rise, says Dr. Wittstein. He estimates that 2% of all people thought to be having a heart attack actually have broken heart syndrome. Among postmenopausal women, the figure could be as high as 5% to 7%, he says.
Takotsubo cardiomyopathy stuns the heart
Although they arent certain, experts believe takotsubo cardiomyopathy is triggered by adrenaline and other hormones that flood the body in response to a stressful event, be it the death of a loved one, the loss of a job, a mugging, or even walking in to your surprise birthday party.
“Any kind of sudden stress response can cause weakening of heart muscle, whether its sudden fearsomeone holding a gun to your heador the distress your body goes through in the middle of a bad infection or stroke,” says Dr. Wittstein.
Stress is involved in 9 out of 10 cases of broken heart syndrome, Dr. Wittstein addsincluding that of the betrayed woman.
Broken heart syndrome may look and feel like a heart attack (which can also be caused by acute stress), but unlike with heart attacks, blocked arteries arent to blame. And broken heart syndrome rarely causes permanent damage to the heart muscle, the way most heart attacks do.
“When we do angiograms of the arteries [in people with broken heart syndrome], there isnt any obstruction of the coronary arteries,” says Nieca Goldberg, MD, the director of the Womens Heart Center at New York University Langone Medical Center, in New York City. “Several weeks or months later, they return to normal heart function.”
Broken heart syndrome is a “temporary dysfunction of heart tissue,” says Dr. Wittstein. “The heart muscle is stunned and not killed, so you dont have permanent cell death of heart tissue.”
There have been reports of death from the syndrome, Dr. Wittstein adds, although they were people in whom the condition was precipitated by a physical trauma, such as a stroke.
According to a 2009 study in the American Journal of Cardiology, cases of the syndrome tend to peak in the summer months, while heart attacks spike during the winter.
Women more susceptible than men
No one knows why broken heart syndrome primarily affects white, postmenopausal women, though speculation naturally rests on the possible role of estrogen.
Eugene Storozynsky, MD, an assistant professor in the Heart Failure, Heart Transplant Unit of Strong Memorial Hospital, part of the University of Rochester Medical Center, in Rochester, N.Y., says that some experts believe that the adrenaline receptors of women may be different than those of men. “Maybe as a result of that, especially when theyre postmenopausal, they may have a potentially higher predisposition to broken heart syndrome,” he says.
People with anxiety or depression are also more prone to the syndrome, and the medications prescribed for those conditions may be partly to blame, Dr. Wittstein says. Of the 200 or so people with broken heart syndrome he and his colleagues have studied, roughly 40% have a history of anxiety or depression, and many have been on antidepressants, he says.
“Its important to at least recognize the potential connection, because some antidepressants, like selective serotonin reuptake inhibitors (SSRIs), affect the metabolism of adrenaline,” he explains. “They inhibit the metabolism of adrenaline so someone who is on one of these drugs may be predisposed to have this happen.”
Fortunately, broken heart syndrome rarely has lasting health effects. In fact, like metaphorical broken hearts, the syndrome usually gets better on its own with time.
If you experience broken heart syndrome, specialists generally provide supportive care (such as diuretics to combat the accumulation of fluid in the lungs), while the body performs its natural process of self-healing. “The prognosis is excellent,” says Dr. Storozynsky. “Usually there is complete recovery and its very rare to have a recurrence.”
There are no official guidelines for preventing a recurrence, says Dr. Wittstein, but he says that reducing stress is always a good idea. “We tell people [that] if they are in jobs or situations that they know clearly cause severe anxiety, they could, at least in the short run, try to remove themselves from that situation,” he says.