From the Guidelines
Broken heart syndrome, also known as Takotsubo cardiomyopathy or stress cardiomyopathy, is a temporary heart condition that mimics a heart attack but is triggered by emotional or physical stress rather than blocked arteries. It occurs when a sudden surge of stress hormones, particularly adrenaline, temporarily stuns the heart muscle, causing one part of the heart (typically the left ventricle) to enlarge and not pump effectively [ 1 ]. Common triggers include the death of a loved one, divorce, job loss, physical trauma, or serious illness. Symptoms include chest pain, shortness of breath, and irregular heartbeat, which can be mistaken for a heart attack. Unlike a heart attack, broken heart syndrome doesn't involve blocked coronary arteries and is usually reversible, with most people recovering fully within days to weeks.
Key Characteristics
- The condition affects women more frequently than men, particularly post-menopausal women [ 1 ].
- While generally not life-threatening, complications can include heart failure, blood clots, or heart rhythm abnormalities, so medical attention is essential if symptoms occur.
- Treatment typically involves supportive care with medications like beta-blockers, ACE inhibitors, or diuretics to reduce heart strain while the heart heals.
- Recurrence of the condition can occur in approximately 5% of cases, mostly occurring 3 weeks to 3.8 years after the first event [ 1 ].
- Patients with cardiogenic shock, particularly those with apical ballooning, should be promptly evaluated for the presence of left ventricular outflow tract obstruction (LVOTO), which occurs in about 20% of cases [ 1 ].
From the Research
Definition and Characteristics of Broken Heart Syndrome
- Broken heart syndrome, also known as Takotsubo cardiomyopathy, apical ballooning syndrome, or stress cardiomyopathy, is a condition where a stressful emotional or physical event causes the left ventricle of the heart to dilate, leading to acute heart failure 2.
- It is characterized by left ventricular dysfunction and ballooning of the left ventricular apex on imaging during systole 3.
- The syndrome is often reversible and has a generally favorable prognosis, with about 95% of patients making a full recovery 2.
Causes and Risk Factors
- The exact cause of Takotsubo cardiomyopathy is unknown, but potential contributors include catecholamine excess and sympathetic nervous system hyperactivity 3.
- It is commonly associated with emotional or physical stress, and predominantly occurs in post-menopausal women 3, 4, 5.
- Patients often have no risk factors for coronary artery disease 4.
Signs and Symptoms
- Signs and symptoms of Takotsubo cardiomyopathy include chest pain, dyspnea, electrocardiographic changes, and elevated levels of cardiac biomarkers 2, 3, 4.
- Patients may also have signs and symptoms of fluid overload and acute pulmonary edema 4.
- The syndrome presents with similar ECG and biomarker indications as acute myocardial infarction, making diagnosis challenging until coronary angiography is performed and reveals no blockage 2.
Treatment and Management
- Treatment is largely supportive, and may include angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) to reduce the likelihood of recurrent episodes 2.
- Beta-blockers are also a widely accepted acute and long-term treatment modality, and may be used to prevent recurrence 3, 6.
- Near complete resolution of left ventricular wall motion dyskinesis occurs in the majority of patients within a month 3.