When Stress Leads to Broken Heart Syndrome

A surge of emotional trauma can trigger a serious cardiac condition

Roni Buckley was 9 years old in 1957 when her mother suddenly passed away from polio. Her mother, 35, was six months pregnant at the time.
While the devastation of losing her mother hit her family hard, it took an unbearable toll on Buckley’s grandfather.

“My mother was his oldest child. They were incredibly close, always playing around and having fun,” Buckley says. “I think her death just took my grandfather’s lust for life away from him.” 

Buckley recalls being at her mother’s wake and witnessing her healthy 59-year-old grandfather in distress.

“He was leaning over my pregnant mother’s coffin, weeping, and saying, ‘I will see you soon.’ He died 12 weeks later,” she says.

As Buckley got older and learned about broken heart syndrome, she believed the condition caused her grandfather’s death.

What is broken heart syndrome?

Broken heart syndrome — also called stress-induced cardiomyopathy or takotsubo cardiomyopathy — can strike healthy people and mostly affects women, according to the American Heart Association (AHA). The disorder often involves temporary weakness of the heart and discomfort similar to a heart attack.

The intense chest pain occurs as a reaction to a surge of stress hormones. 

In many cases, the body releases those stress hormones during an emotionally stressful event.

“[Roni’s] grandfather may have died of this, because of the shock. He may have had other issues and having such stress of losing his daughter six-months pregnant might have been too much,” says Asim R. Zaidi, MD, a cardiologist at Northwestern Medicine Regional Medical Group. 

Zaidi explains that when takotsubo cardiomyopathy occurs, the heart muscle’s main pumping chamber — the left ventricle — takes the shape of a round ball, which resembles a pot that Japanese fishermen use to trap octopuses.

Takotsubo is the Japanese name for that octopus trap, and cardiomyopathy refers to diseases of the heart muscle.

When someone has a heart attack, the culprit often is blockage in the arteries. But in broken heart syndrome, stress hormones lead to changes in the heart.

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He was leaning over my pregnant mother’s coffin, weeping, and saying, ‘I will see you soon.’ He died 12 weeks later.

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“When someone is in that emotional stress state, a huge surge of stress hormones like adrenaline are released. Those stress hormones hit the heart muscles, stunning it, so the heart becomes weak and not able to pump as effectively as it should,” Zaidi says. “That’s why people get chest pain, breathlessness, and other symptoms.” 

Emotional stress — such as the death of a loved one, divorce, or financial loss — can trigger the syndrome, says Philip Krause, MD, a cardiologist at NorthShore University HealthSystem. However, physical stress, such as appendicitis and gallstones, can also cause the condition.

How is broken heart syndrome diagnosed?

Often, people with broken heart syndrome experience symptoms that resemble a heart attack, such as chest pressure, shortness of breath, nausea, or dizziness.

When they go to the hospital, they may undergo an electrocardiogram (EKG) to look for abnormalities that differ from those of a heart attack. Blood tests might show elevation in enzymes that signify heart muscle damage.

When doctors look at the coronary arteries with angiography,they don’t see the blocked arteries they’d expect from a heart attack. “At this point, we take a picture of the heart and see if it’s the takotsubo shape indicative of broken heart syndrome,” Krause says.

Once it’s clear that a heart attack is not happening, Zaidi says he’ll ask patients if something stressful recently occurred in their life.

“They may say, ‘My sister passed away last week,’” Zaidi says. “One response that stood out to me was when a woman said, ‘I lost my wedding ring,’ and she was a widow.”  

Most people fully recover within weeks, and their heart shape returns to normal. Standard care includes medication to prevent further heart failure and rhythm problems. 

“It’s unlikely for patients to die from broken heart syndrome, but it’s not unheard of,” Krause says.

Cardiogenic shock, a condition in which a suddenly weakened heart can’t pump enough blood, can also occur and be deadly if not treated, according to the AHA.

How can I prevent broken heart syndrome?

Because broken heart syndrome is caused by sudden loss or stress, it usually can’t be predicted, Zaidi says.

Researchers in one study, published in 2019 in Frontiers in Neurology, reported a high prevalence of psychiatric and neuro- logical disorders in patients with takotsubo cardiomyopathy. 

Encouraging your loved one to manage pre-existing mental health conditions can help. “Anyone under stress or who has an underlying disorder should not ignore their symptoms,” Krause says. “If they are getting frequent episodes of depression, get their depression evaluated by someone who is trained [to provide] appropriate psychotherapy or medical therapy that may ease their symptoms.”

If a friend or family member has lost a spouse or loved one, pay attention to how they are feeling. If they have chest pain, breathing problems, or behavioral changes, seek help.

“Be aware if the living spouse is not feeling right. 

Don’t think it’s just from grieving,” Zaidi says. “Like anything in medicine, if you catch things earlier, it’s easier to treat and do better.”

Pandemic Anxiety: a Heartbreaker

Physicians across the country have noted a rise in patients experiencing broken heart syndrome due to the economic, physical, and social stresses
of the Covid-19 pandemic.

Philip Krause, MD, a cardiologist at NorthShore University HealthSystem, says that during times of stress, he sees more patients with broken heart syndrome. For instance, his hospital experienced an increase in cases during the financial crisis of 2008.

Given the coronavirus pandemic, Krause says it’s particularly important to pay attention to heart-related symptoms.

“We see a number of people ignoring their symptoms and avoiding coming to the hospital for fear of exposure to Covid-19, and that’s the worst thing you can do. If you have chest pressure, tightness, heaviness, shortness of breath, you should get evaluated right away in a medical facility, so we can assess whether you are having a heart attack,” he says.

However, Asim R. Zaidi, MD, a cardiologist at Northwestern Medicine Regional Medical Group, adds, “Because [the pandemic causes a] constant, persistent stress, it’s unlikely to cause the typical broken heart syndrome associated with sudden, intense stress.”