Broken Heart Syndrome

What is broken heart syndrome?

It’s a commonly used turn of phrase - but can you actually die from a broken heart? The answer is yes - extreme stress can indeed affect your heart and in very rare cases it can be life-threatening.

It’s known as broken heart syndrome, stress cardiomyopathy or takotsubo cardiomyopathy, or similar names. It typically occurs when a person experiences sudden acute stress, extreme emotions or a physical injury that can rapidly weaken the left ventricle, the heart’s main pumping chamber.

The symptoms are often similar to a heart attack, but the good news is that in most cases any change to the heart is temporary, and most people recover completely.

What happens to the body during broken heart syndrome?

During times of extreme mental and physical stress, the body releases a sudden burst of adrenaline and stress hormones. This can cause the small arteries around the heart to constrict which reduces the blood flow to the heart and stuns the heart muscle temporarily.

Whilst the symptoms are almost identical to a heart attack, most heart attacks are typically caused by blockages in the arteries of the heart.

However, most people who have broken heart syndrome have arteries that are not blocked. Rather, because of the surge in stress hormones, the heart just doesn’t pump blood as well as it should, which causes heart attack-like symptoms, as well as rapid but normally reversible heart muscle weakness.

What causes broken heart syndrome?

Around two-thirds of people diagnosed with broken heart syndrome can pinpoint a trigger episode that caused the condition - with a physical cause being the most common reason according to one US study. Emotional stress such as the loss of a loved one was also reported in around 30 per cent of cases.^[1]

But with one-third unable to recall a trigger, it’s believed that there may be other factors at play - involving the endocrine, vascular, and central nervous systems.

Types of extreme stress that can impact the heart

Below are some categories of stress when extreme that can trigger broken heart syndrome. To learn about the day-to-day stress impact on your heart, visit our 'Stress and your Heart' page.

What are the symptoms of broken heart syndrome?

They include:

• Chest pain
• Shortness of breath
• Sweating
• Dizziness

These symptoms may begin as soon as minutes or several hours after an emotionally or physically stressful event. Anyone experiencing these symptoms should head to their nearest emergency department.

How are people diagnosed with broken heart syndrome?

As symptoms are similar to a heart attack, patients will typically undergo tests including ECG, blood tests, heart ultrasound (echocardiogram) and an angiogram to investigate if they have blocked arteries or ruptured plaque.

Once evidence of blocked arteries is ruled out, tell-tale signs of having broken heart syndrome include the heart’s main pumping chamber ballooning when filled with blood, and if the heart is enlarged or an unusual shape. Higher levels of substances called cardiac enzymes are also usually found in the blood.

A cardiac MRI scan may also be performed in some patients.

How is broken heart syndrome treated?

There is no standard treatment for the syndrome. Common heart failure medications such as beta blockers, ACE inhibitors and other related therapies are often prescribed to prevent any further stress on the heart and help with muscle weakness. Diuretics (‘water pills’) may be used if there is a build-up of fluid in the body because the heart isn’t pumping as strongly as usual.

A specialist may also advise ways to reduce stress – such as taking up a gentle exercise program such as yoga or other rehab programs – to avoid a reoccurrence.

Is broken heart syndrome dangerous?

While most patients recover, a severe case of broken heart syndrome can be life threatening. In some cases, it can cause severe heart muscle weakness resulting in:

• Congestive heart failure
• Low blood pressure
• Shock
• Potentially life-threatening heart rhythm abnormalities

The good news is that this condition is usually temporary, and patients can recover completely within days or weeks. Even people who are critically ill with this condition tend to recover.

Who is at risk for getting broken heart syndrome and how common is it?

Older women are by far at the greatest risk with 90 per cent of cases taking place in those aged 58-75. The exact reason for why women are so disproportionately represented is unknown but is thought to be triggered by menopausal changes when the female hormone oestrogen starts to decline.

Whilst women are at far greater risk, research shows that the death rate amongst men is higher than in women.^[2]

Studies suggest broken heart syndrome is responsible for around 2% of people admitted for a suspected heart attack. That figure rises to around 5-7% for women.^[3]

1. WebMD, 'How common is broken heart syndrome?' July, 2011
2. tctMD, 'Following Takotsubo, Men Have Worse Outcomes, Are More Likely to Die Than Women', June 2022.
3. WebMD, op. cit, July, 2011