Broken Heart Syndrome

She suspected a heart attack, but was diagnosed with broken heart syndrome

If you've ever had a scary experience, when your adrenaline is pumping, as you deal with a threat or shock, you may relate to Maria Carraballo's experience. While on vacation in Puerto Rico, Carraballo, 75, was swimming with her two young grandsons, when the current began to pull them away from the shore. "I was holding the boys, trying to keep their heads above the water," she recalls. "It was such desperation," she thought they were going to drown.

Fortunately, a nearby swimmer came to help, and once safely back to shore she thought the event was over. But several hours later she ended up in the emergency room with chest pain and shortness of breath. She was diagnosed with stress cardiomyopathy, also known as broken heart syndrome. You may think of a broken heart as a metaphorical idea, but this is a real condition that can bring on a sudden and dramatic weakening of the heart muscle after a stressful event.

"She's kind of a classic case," says Dr. Joy Gelbman, a cardiologist at New York-Presbyterian and Weill Cornell Medicine, who treated Carraballo once she was back in New York. Typically, people make a full recovery, and are often prescribed medications, such as beta-blockers, temporarily. It's almost like the heart is overworked

Broken heart syndrome, which is also known as Takotsubo cardiomyopathy, can be tricky to diagnose. Some of the tests performed in the emergency room can produce the same results as someone having a heart attack. For instance, there may be changes in an electrocardiogram, or EKG, similar to a heart attack.

Broken heart syndrome can cause an increase in a cardiac enzyme called troponin, in the blood, that is also elevated by a heart attack. "And the echocardiogram — which creates images of the heart — typically shows a characteristic ballooning of the heart muscle," Gelbman explains.

The key difference is that when a person has a heart attack, they have a blockage in one or more of their coronary arteries, but patients with broken heart syndrome don't have blocked arteries.

"That's one of the defining features — there are no serious blockages of heart arteries," Gelbman says. With broken heart syndrome, the weakening of the heart muscle can be caused by a sudden burst of stress hormones that flood the heart, she says.

"The best understanding we have is that the heart reacts very strongly to an adrenaline surge," says Dr. Grant Reed, a cardiologist at the Cleveland Clinic. "That adrenaline surge causes the heart muscle to weaken. It's almost like the heart is overworked," as a result of the stressful event.

When the heart is weakened, blood and oxygen can't effectively circulate around the body, which helps explain the symptoms. It's not clear why some people develop this condition after a stressful event, and though it's still considered rare, research points to an increase in cases.

Reed and his colleagues at the Cleveland Clinic documented more than a 4-fold increase in broken heart syndrome in 2020 during the stressful Covid lockdown period. It was a reminder, Reed says, of how interwoven the mind and body are. "Emotional stress can lead to a physical consequence," he says.

Most people make a full recovery

Reed talks to his patients about the importance of taking care of themselves both physically and emotionally. "Broken heart syndrome is really a great example of the intersection between the two," he says. Fortunately, most patients make a full recovery. "The good news is that broken heart syndrome is usually easy to treat and does not require surgery," says Dr. Sudip Saha, a cardiologist at Kaiser Permanente.

He says some patients feel reassured when they realize they haven't had a heart attack.
"Most people are relieved to hear that in almost all cases — with time and medicine — this can be reversed," Saha says, and the risk of a recurrence is very low. The syndrome is most common in women over the age of 50, though cardiologists report seeing the condition in a broad range of patients, including middle aged men. In about 1 in 3 cases, there's no specific event that causes the cardiomyopathy. Sometimes, the onset is linked to a stressful or anxious period.

Saha says at a time when the condition seems to be on the rise, it's important for people to know the symptoms and be aware of the benefits of managing anxiety and stress.