We learn about broken hearts at a very young age. Children’s books and cartoons show the heart shape broken into two pieces, usually with a zigzag at the cleft.
Most people relate a broken heart to a failed relationship. But in the last few years we’ve treated more patients for physical conditions related to a “broken heart.”
While it’s mysterious, broken heart syndrome is indeed real. It affects mostly older women, usually in their 70s or older, and many times it happens after the patient has experienced a stressful event.
Broken heart syndrome, also known as takotsubo cardiomyopathy, was first described in 1990 in Japan. It is a sudden weakening of the left ventricle of the heart, the chamber that pumps blood to all parts of the body.
Patients with broken heart syndrome may experience chest pain or tightness. Some also may experience shortness of breath. Many patients believe they are having a heart attack, but when we do our examination, we find no blockages in the heart vessels. Many of these people develop weakness of the heart and electrocardiographic changes which typically normalize over time.
Causes of broken heart syndrome
The exact cause of broken heart syndrome is not fully understood, but many doctors believe it can be triggered by mental or physical stress. It can be a traumatic event, such as the death of a spouse, or something that causes the patient to worry, such as an upcoming surgery.
Because it primarily affects older women, some have hypothesized that the condition may be linked to estrogen levels.
I was an intern the first time I witnessed broken heart syndrome. The patient was elderly and sick. Her daughter told us to be very careful and asked us to spend extra time with her. She was worried that any other kind of approach could “scare her to death.”
Another time, more recently, a patient had arthritis and was soon going to have a hip replaced. The looming procedure caused her a lot of worry, which we believe caused the issue with her left ventricle.
Broken heart syndrome is not considered a rare condition. While its exact frequency is unknown, most studies suggest it affects 1 to 2 percent of patients who have symptoms similar to a blockage of blood supply to the heart. Those symptoms include chest pain, tightness, and/or shortness of breath.
Treatment and recovery
Fortunately, very few people die from broken heart syndrome. It’s often a scary situation for the patient and his or her family, but many patients recover without any lasting damage.
We prescribe the same kinds of medications for broken heart syndrome as we would for a patient who has had a heart attack: beta-blockers and ace inhibitors. In addition, we help the patients work through situations that are causing them stress.
We’ve found that this combination of removing the stressor and prescribing medication often helps the patient’s heart function return to normal.