Broken heart syndrome, also known as stress cardiomyopathy or takotsubo syndrome, occurs when a person experiences sudden acute stress that can rapidly weaken the heart muscle.

Ilan Wittstein, M.D., the program director of the Johns Hopkins Advanced Heart Failure Fellowship, answers some common questions about broken heart syndrome and how it can be treated.

What is broken heart syndrome?

Broken heart syndrome is a condition that can cause rapid and reversive heart muscle weakness, also known as stress cardiomyopathy.

What causes broken heart syndrome?

Two kinds of stress — emotional or physical — often cause broken heart syndrome. But while most people with this condition experience a stressful event, up to 30% of patients have no identifiable trigger at the time of their initial symptoms.

Emotional Stressors

Emotional stressors include:

• Grief
• Fear
• Extreme anger
• Surprise

Physical Stressors

These conditions include:

• High fever
• Stroke
• Seizure
• Difficulty breathing (such as an asthma attack or emphysema)
• Significant bleeding
• Low blood sugar

What are the symptoms of broken heart syndrome?

The symptoms of broken heart syndrome can mimic symptoms of a heart attack, including:

• Chest pain
• Shortness of breath
• Diaphoresis (sweating)
• Dizziness

These symptoms may begin as soon as minutes or as long as hours after an emotionally or physically stressful event.

How does sudden stress lead to heart muscle weakness?

When you experience a stressful event, your body produces hormones and proteins such as adrenaline and noradrenaline that are meant to help cope with the stress.

The heart muscle can be overwhelmed by a massive amount of adrenaline that is suddenly produced in response to stress. Excess adrenaline can cause narrowing of the small arteries that supply the heart with blood, causing a temporary decrease in blood flow to the heart.

Alternatively, the adrenaline may bind to the heart cells directly, causing large amounts of calcium to enter the cells. This large intake of calcium can prevent the heart cells from beating properly. It appears that adrenaline’s effects on the heart during broken heart syndrome are temporary and completely reversible — the heart typically recovers fully within days or weeks.

Is broken heart syndrome dangerous?

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 can improve very quickly if patients are under the care of doctors familiar with the syndrome. Even people who are critically ill with this condition tend to recover.

How does broken heart syndrome differ from a heart attack?

Most heart attacks occur due to blockages and blood clots forming in the coronary arteries, which supply the heart with blood. If these clots cut off the blood supply to the heart for a long enough time, heart muscle cells will die, leaving the heart with scar tissue and irreversible damage.

People experiencing broken heart syndrome frequently have normal coronary arteries and often do not have severe blockages or clots. The heart cells of people experiencing broken heart syndrome are stunned by the adrenaline and other stress hormones. Fortunately, this gets better very quickly in most cases, often within weeks or just a few days. Most patients don’t have scar tissue or damage.

I am under a great deal of stress every day. Is it possible that I have been walking around with broken heart syndrome and did not even know it?

Broken heart syndrome appears to be a condition that comes on suddenly and resolves quickly. If you are a person who frequently has symptoms of chest pain or shortness of breath when under significant stress, you should be evaluated by your doctor. If your symptoms are chronic, it is unlikely that you have broken heart syndrome.

Who is at risk for getting broken heart syndrome?

You may be at higher risk for getting broken heart syndrome if you are a middle-aged woman. The risk of developing the condition increases five times after the age of 55. While the syndrome has been reported in younger women, in men and even in children, the vast majority of patients are post-menopausal women. The exact reason for this is unknown, but it is believed that because the female hormone estrogen helps to protect the heart from the harmful effects of adrenaline, women become particularly vulnerable to the effects of sudden stress as they grow older and their estrogen levels decline. Other risk factors for developing this condition include a history of anxiety, depression or neurologic illness.

Will a person experience broken heart syndrome multiple times?

Studies suggest that a person who has experienced broken heart syndrome will most likely not have more episodes. The majority of patients don’t experience a second episode — up to only 5% have a recurrent episode.

If I have had broken heart syndrome, what is my long term prognosis?

Short and long term prognosis depends on the type of stressor that causes the syndrome in the first place. Patients who develop broken heart syndrome due to emotional triggers have a good five year prognosis. Patients with physical stressors have a worse prognosis due to neurologic events, like a stroke. Since the heart muscle is not permanently damaged, most patients with broken heart syndrome continue to live healthy lives.

If I am diagnosed with broken heart syndrome, what treatment should I receive?

It is important to follow up with a cardiologist who is familiar with this syndrome and who can tell you when your heart muscle has fully recovered. Early on, the cardiologist may want to treat you with standard medications for heart muscle weakness, but this will depend on several factors including your heart rate and blood pressure.

Your doctor may suggest an exercise program including cardiac rehabilitation. Avoiding stressful situations if possible is always recommended, and interventions to reduce stress such as biofeedback, meditation, yoga, physical rehabilitation and exercise can be very helpful to some patients with this syndrome.