“You broke my heart.”
Country song lyrics and classic movie lines immortalized the phrase. But it’s not just a figure of speech.
“It actually happens,” said Sudhir Mungee, MD, interventional cardiologist at OSF HealthCare.
“The term ‘broken heart’ – even though it is used figuratively – is literally right. These are patients who have severe heart muscle dysfunction because some event has broken their heart.”
Symptoms and causes
Takotsubo is the Japanese word for octopus trap, which is what a human heart with this condition resembles. Cardiomyopathy is a weakening of the heart muscle. The left ventricle balloons, due to an intense physical or emotional trauma, and some part of the heart maintains its ability to contract.
Primary symptoms are the same as an acute heart attack – intense chest pain and shortness of breath. Blood tests, X-rays and electrocardiogram (EKG) results can be similar to a heart attack.
So the person’s history becomes important to diagnosing the ailment. Loss of a loved one, financial distress, physical violence – any sort of physical or emotional trauma experienced or witnessed – can lead to broken-heart syndrome.
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“When you talk to the patient about what happened, they tell you that a few weeks back they had this loss – so much grief or shock in their life. Then you realize that it could be different from an acute heart attack,” Dr. Mungee said.
“Typically, the person will experience trauma on Day 1. From Day 1 to Day 5, they experience a surge of hormones. They begin to have chest pain, shortness of breath. They come to the emergency department, and it can look like they’re having a heart attack, but they’re not. Their main blood vessels are open, but the heart muscle is weak. They have a broken heart.”
The value of peace
Most people are aware of preventive measures against an acute heart attack: Don’t smoke, exercise regularly, eat a healthy diet and avoid stress. Some of those same steps apply to preventing broken-heart syndrome.
But there’s more.
“The mind can rule the heart adversely,” Dr. Mungee said. “Your body is your state of mind. There is value to meditation, which by itself has been shown to reduce blood pressure. Stress increases blood pressure, but meditation reduces it. There is value to being at peace.”
When that peace is disrupted by a traumatic event – for example, the loss of a spouse or other loved one, a significant financial challenge or being subjected to physical or verbal violence – the resulting stress can have adverse effects on the heart.
Take symptoms seriously
Dr. Mungee believes broken-heart syndrome is underreported.
“Many people going through this don’t come to the hospital,” Dr. Mungee said. “They think it’s just part of their emotional reaction to a traumatic event. They’re feeling heavy in the heart. They’re upset and feel out of breath.
“Do not underestimate these symptoms,” Dr. Mungee warned. “It can get serious. If you are aware of these symptoms, it’s not just because you’re upset. It’s because something major is going on in your body. The mortality rate for broken-heart syndrome is about 5%, which is comparable to an acute heart attack.”
Quicker, complete recovery
The good news is that, unlike an acute heart attack, broken-heart syndrome usually does not cause lasting damage to the heart. Recovery also tends to be quick.
“We have to watch them for the first couple of days or so, but once they’re through the first 48 to 72 hours, they cure up as fast as they went downhill,” Dr. Mungee said. “It’s like a state of stunning or numbness of the heart muscle on receiving traumatic news. The further you go away from the trauma, the more the heart recovers.”
Emotional support is important
Broken-heart syndrome can happen to anybody. But the American College of Cardiology reports that about 90% of broken-heart syndrome cases occur in post-menopausal women. Some studies suggest that there might be a genetic component, but more research is required.
There is also about a 5-10% recurrence rate within one to 10 years, Dr. Mungee said.
“But it’s mostly in the population that’s at risk: middle-age females who are post-menopausal, diabetic, or have a history of psychiatric problems such as anxiety, depression or schizophrenia. If they have COPD, emphysema or asthma, they’re also predisposed to broken-heart syndrome if they were to experience intense emotional trauma.
“If you are susceptible to emotional trauma, you must have appropriate family and emotional support.”
If you are at risk for broken-heart syndrome, counseling can help. If you experience symptoms, see a cardiologist. Talk to your primary care provider and ask for a referral.