The science behind “broken heart syndrome”

During Valentine’s season, it’s not hard to run across articles on what’s come to be called broken-heart syndrome. These often open with a touching story of a long-married couple that died within days of each other.

Many of these articles lump two completely different conditions under the “broken heart” heading. One is stress cardiomyopathy, sometimes known as takotsubo cardiomyopathy. The other is myocardial infarction, better known as a heart attack.

A huge sudden stress—like news that a loved one has died, experiencing an earthquake, or learning that your accountant has stolen all of your retirement savings—unleashes a torrent of stress hormones. Most of us weather this storm just fine. Others don’t.

Stress cardiomyopathy

Stress cardiomyopathy is a weakening of the left ventricle, the heart’s main pumping chamber. The bottom portion of the left ventricle balloons out each time the heart beats. It was originally called takotsubo cardiomyopathy because the shape of the left ventricle resembles the tako-tsubo, a Japanese trap used to catch octopi (see image). Exactly how stress makes this happen isn’t yet known.

An x-ray of the left ventricle in a person with stress cardiomyopathy (left) shows the left ventricle ballooning out with each beat. The shape is similar to that of a round-bottomed, narrow-necked tako-tsubo pot (right), which is used to catch octopi in Japan.

Calling this “broken-heart syndrome” is cute, but limited. In addition to happening after news of unexpected loss, stress cardiomyopathy can be caused by an accident, episode of severe fear or pain, fierce argument, or even something that’s supposed to be pleasurable, like a surprise party or winning the lottery.

Stress cardiomyopathy feels like a heart attack—pain in the chest, left arm, jaw, or upper back; feeling short of breath or lightheaded; the sudden onset of nausea, dizziness, or a cold sweat. It even looks like one on an electrocardiogram. But none of the coronary arteries are blocked, the hallmark of a heart attack.

Treating stress cardiomyopathy generally involves the use of heart-protecting medications such as beta blockers, ACE inhibitors, and diuretics. Over the course of a week or longer, the ballooning tends to fade and the left ventricle usually recovers its pumping power.

(You can read more about stress cardiomyopathy in this article from the Harvard Women’s Health Watch.)

Myocardial infarction

Plaque is the cholesterol-filled gunk that builds up inside arteries throughout the body. Small plaques are silent; large ones can cause angina—chest pain or pressure brought on by physical activity or emotional stress. A big, sudden stress can lead to a heart attack two ways: by causing plaque to burst, or by triggering a dangerous heart rhythm.

When a plaque bursts, it spews a mixture of activated cholesterol, white blood cells, and other debris into the bloodstream. A blood clot forms to seal the leak and contain the damage. If the clot is so big that it completely blocks the artery, blood stops flowing to a section of heart muscle. Without oxygenated blood, that area of the heart begins to die. That’s a heart attack.

A surge or stress hormones can also interfere with the precisely timed signals that keep the heart beating steadily. It can make the left ventricle beat so fast and so erratically that it never has time to relax and fill with blood. Circulation to the brain and body stops. This situation, known as ventricular fibrillation, is a common cause of sudden (and deadly) cardiac arrest.

Over the years, a number of studies have shown that sudden stress from earthquakes, wars, sporting events, and more are followed by a spike in heart attacks. It happens with sudden loss and grief, too. A new study from Harvard-affiliated Beth Israel Deaconess Medical Center showed that the risk of having a heart attack is 21 times higher than normal within the first day after a loved one dies. The elevated risk drops as the days pass. The report was published in the journal Circulation. (You can read more about sudden stress and heart attack in this article from the Harvard Heart Letter.)

Prevention is tricky

There’s no way to steel yourself against the shock of bad news. All you can hope for is that your heart can handle it. The best way to get it ready is by making the kinds of healthy daily choices that protect the heart and prevent the buildup of plaque. You know which ones I mean—exercising, eating a healthy diet, not smoking, and the like.

If your heart has been broken and you are in mourning or grief, take care of yourself, advise the Beth Israel Deaconess researchers. Try to eat and sleep, don’t forget to take any needed medications, and take seriously symptoms such as chest pain.