Broken heart syndrome is better known by healthcare providers as “stress cardiomyopathy.” Cardiomyopathy is simply the medical term for any disorder of the heart muscle.
Stress cardiomyopathy is a recently-recognized cardiac condition that is dramatic and severe, but that is usually reversible and transient—if treated the right way. And, to be clear, this type of broken heart syndrome generally has nothing to do with failed romances.
Overview
“Stress cardiomyopathy” is a much better term for this condition than the more popular “broken heart syndrome.” We typically think of a broken heart as something that occurs after a relationship breaks up, not something that happens after severe emotional distress.
Nonetheless, this terminology has resulted in lots of publicity, and the knowledge of this syndrome consequently has been rapidly and widely disseminated—and that widespread awareness is good.
In stress cardiomyopathy, a portion of the heart muscle—often a large portion—suddenly ceases to function, leading to acute heart failure.
With aggressive medical care, the condition is generally transient and the heart muscle returns to normal function within a few days or weeks. However, if medical care is delayed, stress cardiomyopathy may be fatal.
Symptoms
The condition typically manifests with symptoms suggesting an acute heart attack—such as severe pressure-like chest pain, dyspnea (shortness of breath), and a sense of impending doom.
Nearly 90% of people who have this condition are women with an average age of 66, but it is not known why stress cardiomyopathy affects women disproportionately. In fact, stress cardiomyopathy is a truly unique condition:
The symptoms of stress cardiomyopathy are so sudden and so severe that it is nearly inconceivable that anyone who develops it will fail to seek medical help. And the physical manifestations of the condition are so obvious that no healthcare provider who sees female patients could fail to realize that something serious is going on. So, as bad as stress cardiomyopathy is, at least there is little danger it will be ignored either by its sufferers or by medical personnel.
This stands in stark contrast to several other cardiac conditions that are far more frequent than stress cardiomyopathy. Chief among these are angina and heart attacks. These conditions are as frequent and as dangerous in women as in men, but they often present with “atypical” symptoms.
Causes
The cause of stress cardiomyopathy is unknown, but most experts blame it on an unusual response to stress hormones, such as adrenaline, after emotional trauma.
The condition may be related to microvascular angina as well, which is caused by constriction of microvessels (tiny blood vessels) within the heart muscle. Others have postulated that this condition may be related to coronary artery spasm.
Diagnosis
When first evaluated, people who have stress cardiomyopathy are initially thought to be having massive heart attacks. However, the changes on their ECGs are not typical for a heart attack and the cardiac enzyme tests that are supposed to confirm a heart attack are found not to be significantly elevated.
Furthermore, when taken to the catheterization laboratory, their coronary arteries are found to be open. In true heart attacks, one of the coronary arteries would be occluded.
Finally, many people with stress cardiomyopathy are found to have a peculiar type of heart muscle weakness (cardiomyopathy) on echocardiography, where a portion of their left ventricle “balloons” outward in an unusual and distinctive fashion. In Japan, where this condition was first described, the distinctive ballooning of the left ventricle is said to resemble an octopus trap, or “takotsubo,” so the condition is called takotsubo cardiomyopathy.
Treatment
Many people with stress cardiomyopathy initially have severe heart failure and require aggressive and intensive cardiac care. Fortunately, with aggressive medical care, not only do they survive, but their cardiomyopathy usually completely resolves within a few days to weeks.
You should always consult with your healthcare provider to find the best treatment approach. To help have that conversation, use our Healthcare Provider Discussion Guide below.
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