Myth or Fact: Can a "Broken Heart" kill me?

Have you ever wondered where the analogy of a broken heart originated from? Well, either way, don’t forget to show your appreciation to the people closest to your heart this Valentine's Day because they might have more of an effect on your heart health than you originally thought.

Romantic comedies always love to portray dramatic break ups. I’m sure we can all relate, at least a little, to the character who just got blindsided and broken up with by the person who they thought was the “one”.  Now, they are in some form of emotional shock or life crisis. They can barely get out of bed. They feel miserable and often look miserable. They spend hours of their day crying and moping around. And most likely, their work and social life will begin to slip. It’s almost like they are literally going to die of a “broken heart".

And while we might get a comical kick out of these classically dramatic (but funny) scenes, getting dumped in real life sucks and so does feeling broken hearted. So, are these movies just being overly melodramatic when making the connection of deep, emotional pain with real physical pain? Or, maybe, there is some truth to it?

I’m sure you’ve heard of a similar situation, where longtime married sweethearts that where together for decades, die within just a few days of each other. A tragedy or a love story? Well that’s for you to decide. Bereavement is never easy and losing a loved one can be really emotionally devastating. But, the more important question is how does this emotional despair affect our health and our heart?

Because, guess what? It’s actually possible to suffer from a REAL BROKEN HEART. Unfortunately, in some cases, a bad break up or losing someone very close to your heart can cause enough emotional trauma and stress that it will actually cause REAL PHYSICAL DAMAGE to one’s actual heart. And, yes, it’s even recognized in the medical field as a real phenomenon and it’s called “Broken Heart Syndrome”.

Broken heart syndrome is usually caused by extremely stressful and/or emotional situations, such as experiencing the death of a loved one, which is why it’s also called stress-induced cardiomyopathy. It can also be triggered by a bad divorce, a difficult breakup, a long physical separation from a loved one, an act of strong betrayal or a romantic rejection. It can also be caused by severe physical trauma like after a rapid onset of a very serious physical illness or going through an invasive surgery. All of these examples I just listed have some sort of a negative emotional or physical connotation to it. We all know someone who has gone through a really bad divorce and how stressful it can be. But, guess what? It can even happen after receiving really good news or experiencing a rush of positive emotions, such as winning the lottery.

Other examples of stressful triggers include:

People who are suffering from broken heart syndrome may start experiencing sudden chest pains (angina) and experience other signs and symptoms that are very similar to a heart attack like chest tightness, shortness of breath and general weakness. This is also why broken heart syndrome can be easily misdiagnosed as a heart attack. Patients show similar dramatic changes in heart rhythm and blood tests show elevated levels of similar blood markers. Patients can have episodes of hypotension (low blood pressure), which can cause a temporary loss of consciousness (known as syncope or fainting) usually due to insufficient blood flow to the brain. Diaphoresis (excessive sweating), palpitations (a fast-beating, fluttering or pounding heart) and nausea are all common symptoms as well. Sounds just like a heart attack, doesn’t it?

Surprisingly, this syndrome can even happen in people who are considered very healthy and have no previous history of any cardiovascular or heart disease. Well, actually this is the case for the majority of people suffering from broken heart syndrome. How can these individuals go the majority of their life with a perfectly healthy heart, but then experience a very specific stressful event and then all of a sudden suffer from symptoms of massive heart attack or even go into complete heart failure?

Well, unfortunately, the exact cause of of broken heart syndrome isn't completely understood yet. Experts suggest it’s due to a sudden surge in stress hormones, such as adrenaline, which basically stuns the heart. This triggers changes in the heart’s muscle cells and/or coronary blood vessels, which prevents the left ventricle (the heart’s main pumping chamber) from contracting as effectively. Now the heart cannot pump enough blood to the rest of the body. As a result, the heart can go into abrupt heart failure.

The difference between the two is that a heart attack is caused by heart disease, meaning a person who is suffering from a heart attack most likely had some form of pre-existing heart disease, such as clogged or blocked arteries due to plaque build up (atherosclerosis). Whereas people with broken heart syndrome generally do not have enough blockage to cause a heart attack and in some cases show no signs of blockage in their arteries. Instead, it’s caused by a sudden rush of stress hormones, such as adrenaline, due to sympathetic nervous system overstimulation that’s in response to a server emotional or physical stressor. This greatly weakens the heart’s left chamber muscle or the left ventricle, which causes a temporary disruption in the heart's normal pumping activity. Although, usually only one area of the heart is affected, it causes the heart to enlarge and become transiently very weak. As a result, the heart as a whole cannot pump as well. The remainder of the heart that is not affected is either able to continue functioning normally or will compensate by contracting even more forcefully.

In order to rule out a heart attack and make a clinical diagnosis of broken heart syndrome, clinicians have to do a little investigating. An electrocardiogram (EKG) of someone suffering from a “broken heart” may show similar abnormalities to those who are experiencing a heart attack—specifically ST-segment elevation, which is the main diagnostic characteristic of a heart attack when only using an EKG. After someone has a heart attack, their EKG will always show ST-segment elevation. Blood tests also show similar results. Both show a rapid increase in the same cardiac biomarkers (substances released into the bloodstream when the heart is damaged). But, in a patient experiencing broken heart syndrome, there’s usually smaller rise in cardiac biomarkers compared to a patient experiencing a heart attack. Therefore, more advanced imaging studies are needed to rule out a heart attack, such as an echocardiogram (echo) and an angiogram. An coronary angiogram is a special type of x-ray imaging that’s used to detect the amount of blockage in your heart’s blood vessels. This test is essential for differentiating broken heart syndrome from a heart attack because like I mentioned earlier, unlike a heart attack, patients with broken heart syndrome usually have no signs of blockage in their arteries.

Another name for broken heart syndrome is Takotsubo cardiomyopathy. The Japanese scientists that first discovered this condition over 30 years ago, all thought that the change of shape in the heart’s left ventricle formed a similar shape to an octopus pot, or 'takotsubo' in Japanese (hence the name), which has a narrowed neck and a rounded bottom just like the pot-like shape of the stunned heart in broken heart syndrome. This unique shape is nicely depicted in the picture below.

(Image from: Can Your Heart Literally Break? Katherine A. Boyle, 2/10/2012)

Now, this is why an echo (an ultrasound image of the heart) is also very useful in distinguishing broken heart syndrome from a heart attack. An echo is able to show the abnormal bulging or ballooning of the lower part of the left ventricle (apex) that is a unique characteristic to broken heart syndrome and is termed apical ballooning. And when the heart contracts (systole), the bulging ventricle resembles a takotsubo. Someone who is having a heart attack will not show this change. 

Apical Ballooning and the Tako-tsubo

(Image from Takotsubo Cardiomyopathy (broken-heart syndrome). Harvard Health, 4/2/2018)

Image A is an x-ray of the left ventricle with apical ballooning, a reversible abnormality characteristic of takotsubo cardiomyopathy. When the heart contracts, the midsection and tip (apex) of the left ventricle balloon out, while the area above, called the base, contracts normally. Image B shows a tako-tsubo. As you can see, the shape of the round-bottomed, narrow-necked vessel is very similar to the shape of the left ventricle.

In Summary, Broken Heart Syndrome Features Include:

Who’s at risk?
In general, women are much more likely to suffer from broken heart syndrome than men. And it’s especially common in older females who have just recently lost their husbands. Actually, more than 90% of the reported cases occur in women ages 58 to 75. Researchers believe that many cases might also go unreported and around 5% of women who were evaluated for a heart attack, actually were suffering from broken heart syndrome. The reason why older women are more susceptible to this condition is believed to be due to reduced levels of estrogen after menopause (Stice et al., 2009).

Risk Factors of Broken Heart Syndrome Include:

  1. Sex: This condition affects far more women than men. Around 90% of cases occur in women. That’s a huge disparity.  
  2. Age: Increasing age puts you at a higher risk of broken heart syndrome. Most people who experience this condition are older than 50.
  3. History of a Neurological Condition: People with neurological disorders like epilepsy (seizure disorder) or severe head injuries are at greater risk for developing broken heart syndrome.
  4. History of a Psychiatric Disorder: If you’ve ever had or currently have a mental disorder (i.e. anxiety or depression) you are at higher risk of developing broken heart syndrome.
  5. Comorbidities: People with other chronic medical conditions, such as obesity, hypertension, dyslipidemia and diabetes, are more likely to experience  broken heart syndrome. reports a review of clinical studies in the American Journal of Medicine, February 2015.
  6. Smoking: People who smoke are more likely to experience broken heart syndrome.

Thankfully, for the majority of cases, broken heart syndrome is usually only temporary and most people are able to fully recover within just weeks. And although death from a “broken heart” is extremely rare, it’s still possible in some cases. This is because it can cause irregular heart beats (arrhythmias) that eventually lead to cardiogenic shock, which is when the heart is all of a sudden dramatically weakened and is unable to pump enough blood throughout the body to meet its needs to function normally. This shock to the body is dangerous and without immediate treatment it can be fatal. It’s also the most common cause of death when one dies from a heart attack. But the good news is, unlike a person experiencing a heart attack, that once a person recovers from their “broken heart”, they are at very low risk for ever experiencing it again.

Treating Broken Heart Syndrome

Technically, there aren’t really any evidence-based guidelines for treating broken heart syndrome yet. But, thankfully, most people with this condition will recover rapidly. It usually takes a couple weeks up to a month to fully recover, whereas it takes a couple months to recover from a heart attack. And, unlike a heart attack, patients usually will not have any long-term damage to their heart’s muscle cells and normal pumping activity. Death is rare, but  heart failure does occur in about 20% of patients. Other rarely reported complications include: arrhythmias (abnormal heart rhythms), obstruction of blood flow from the left ventricle, and rupture of the ventricle wall.

Patients being treated for broken heart syndrome are usually put on standard heart failure medications, such as beta blockers, ACE inhibitors, and diuretics (water pills), to help improve heart muscle contraction. And for the few patients who also have signs of blockage in their arteries, they will also have to be treated with aspirin and other therapies that help reduce plaque build up. In order to prevent the condition from reoccurring, sometimes patients will have to be put on beta blockers (and sometimes in combination with alpha blockers) indefinitely because it helps decrease the effects of stress hormones, especially adrenaline, which caused the initial stunning of the heart. Another very important part of treatment is reducing and alleviating any physical or emotional stress that most likely played a role in triggering the condition, as well as reducing stress in general and learning new coping mechanisms.

What’s the Takeaway Message?
Is it true that you can have a heart attack or stroke from a broken heart? Although rare, it can happen. On the day of love, what is that reality of a real broken heart, is to really show you just how big of a role stress, emotional or physical, can play in affecting your heart health, as well as your mental health and social support.

Fun Facts

  1. Former President George H. W. Bush might have passed away from broken heart syndrome. Bush's former White House photographer, David Valdez, who began serving as his official photographer when he was still vice president to Ronald Reagan, told ABC News that many thought Bush would die soon after Barbara Bush passed away on April 17, 2018 because they were always so in love. Just a couple days after Mrs. Bush passed away, he was admitted into the hospital. And seven months later, George H.W. Bush was said to be still heartbroken over the death of his wife when he died on November 30, 2018.
  2. It’s possible that broken heart syndrome caused the death of actress Debbie Reynolds, the mother of actress Carrie Fisher, who died just one day after her daughter passed away from a heart attack in late 2016.
  3. Former NFL quarterback, Doug Flutie, announced that his mother likely suffered from broken heart syndrome. She died just within one hour of his father, who passed away due to a traditional heart attack. They were married for over 56 years!
  4. The iconic heart shape as a symbol of love is traditionally thought to come from the silphium plant, which was used as an ancient form of birth control.
Sources:American Heart Association. (2019). Is Broken Heart Syndrome Real? https://www.heart.org/en/health-topics/cardiomyopathy/what-is-cardiomyopathy-in-adults/is-broken-heart-syndrome-real. | Boyle, K. A. (2012). Can Your Heart Literally Break? SiOWfa12: Science in Our World: Certainty and Controversy. http://www.personal.psu.edu/afr3/blogs/siowfa12/2012/10/can-your-heart-literally-break-3.html. | Derrick, D. (2009). The “Broken Heart Syndrome”: Understanding Takotsubo Cardiomyopathy. Crit Care Nurse;1(29):49-57. | Mayo Clinic Staff. (2016) Broken Heart Syndrome. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/broken-heart-syndrome/home/ovc-20264165. | Tomich, E. B. (2017). Takotsubo Cardiomyopathy. Medscape. http://emedicine.medscape.com/article/1513631-overview. | National Heart, Lung and Blood Institute. (2014). What is Broken Heart Syndrome?  https://www.nhlbi.nih.gov/health/health-topics/topics/broken-heart-syndrome. | Stice, J. P., Lee, J. S., Pechenino, A. S., & Knowlton, A. A. (2009). Estrogen, aging and the cardiovascular system. Future cardiology, 5(1), 93-103. | https://www.heart.org/en/health-topics/cardiomyopathy/what-is-cardiomyopathy-in-adults/is-broken-heart-syndrome-real| https://my.clevelandclinic.org/health/diseases/17857-broken-heart-syndrome | https://www.health.harvard.edu/heart-health/takotsubo-cardiomyopathy-broken-heart-syndrome| https://www.cardiachealth.org/your-heart/heart-failure/broken-heart-syndrome/| https://abcnews.go.com/US/george-hw-bush-heartbroken-wife-barbaras-death-died/story?id=59564584
Author
Arash Bereliani, M.D., M.S., F.A.C.C. Beverly Hills Institute For Cardiology & Preventive Medicine

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