New clues about "broken heart" syndrome

As the name suggests, "broken heart" syndrome can arise in response to grief and other intense emotions. The symptoms — which include sudden, squeezing chest pain and shortness of breath — mimic those of a heart attack.

However, this often reversible but potentially serious condition is more commonly precipitated by physical stress caused by severe illness or surgery. Most cases of the syndrome occur in women. But the proportion of cases recognized in men has risen in recent decades, according to a study published Sept. 24, 2024, in the Journal of the American College of Cardiology.

The findings come from an international registry of nearly 4,000 people who were diagnosed with the condition between 2004 and 2021. The registry uses the original (and now preferred) term: takotsubo syndrome, which was coined by the Japanese physicians who first described it in the early 1990s. During an episode, the heart takes on an unusual shape that resembles a tako-tsubo (octopus pot), a traditional clay vessel a fisher-man uses to trap an octopus.

The new report provides a more modern view of takotsubo syndrome, says Dr. Michael Osborne, a cardiologist at Harvard-affiliated Massachusetts General Hospital. "It shows the diversity of possible causes and presentations of takotsubo syndrome and gives us a better sense of how people may be affected," he says. For example, men now make up 15% of cases — up from 10% in 2004. But this shift and other changes may stem from increased awareness and diagnoses rather than an actual change in the demographic, he adds.

Takotsubo triggers

Over the years, the recording of physical triggers for takotsubo syndrome rose from 39% to 58% of cases. They included serious medical conditions such as stroke, surgery, infection, cancer, and injuries. About one-third of all cases were attributed to emotional triggers, most of which stemmed from either grief or loss, anger or frustration, or interpersonal conflicts. But a small number were spurred by positive events, a phenomenon dubbed "happy heart syndrome" that, for unknown reasons, was mainly seen in men, says Dr. Osborne. Causes reported in these cases included weddings, surprise parties, and the birth of a grandchild.

All of these triggers activate the body's fight-or-flight response, prompting an outpouring of stress hormones such as adrenaline. "This surge of hormones stuns the heart's microscopic vessels, limiting blood flow to part of the heart," explains Dr. Osborne. This insult may temporarily alter the shape of the left ventricle, the heart's main pumping chamber. Usually, the bottom tip of the heart balloons outward while the top narrows, creating the shape of an octopus pot. But sometimes, the midsection of the ventricle swells instead, creating a shape more akin to an amphora, an ancient Greek vase. The prevalence of this less-common heart shape increased from 18% to 28% over the registry's study period.

Most people fully recover within weeks to months. But the registry data suggest that those who also have other serious health conditions face a higher risk of dying within two months after a takotsubo syndrome diagnosis.

Diagnosing the problem

Doctors start their evaluation with an electrocardiogram (ECG), a test that records the heart's electrical activity. The ECG may show abnormalities typical of heart muscle injury, which can occur from either a heart attack or takotsubo syndrome. Both conditions can also cause a rise in blood levels of troponin, a protein released from damaged heart muscle.

A coronary angiogram (a dye-enhanced x-ray of the heart's arteries) may be done to check for a blockage that would indicate a heart attack. But in takotsubo syndrome, the heart's arteries are clear. A heart ultrasound (echocardiogram) can reveal the characteristic change in the heart's shape to confirm the diagnosis.

Mending a broken heart

Treating takotsubo syndrome often includes blood pressure drugs, including ACE inhibitors, angiotensin-receptor blockers, and beta blockers, which help lower the heart's workload and tamp down the body's stress response.

There's no direct evidence that stress reduction can prevent takotsubo syndrome or its recurrence. But many clues suggest practices such as meditation and deep breathing can help by modifying activity in brain regions that respond to stress, Dr. Osborne says. Other than a small time investment, there are no downsides to practicing stress-busting techniques — and it may lower your risk of other heart-related conditions. Harvard Health Publishing's report Stress Management provides details and advice.

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