It Is More Common Than You Think
In 2015, the mother of former NFL quarterback Doug Flutie died less than an hour after her husband of 56 years passed away, even though she had not been ill. Flutie wrote on Facebook, “They say you can die of a broken heart, and I believe it.” The following year, actress Debbie Reynolds unexpectedly died four days after the passing of her daughter, actress Carrie Fisher. Headlines blared, “Can someone die of a broken heart?”
Dying from a broken heart sounds like something that happens only in romance novels. But the fact is, there is a cardiac phenomenon called broken heart syndrome, in which the heart muscle is overwhelmed by stress hormones released due to intense emotions such as grief, anger, fear or surprise. Temporarily stunned, the heart struggles to pump, and that leads to heart attack–like symptoms such as shortness of breath, angina (chest pain), dizziness and sweating.
The condition is also called stress cardiomyopathy or Takotsubo cardiomyopathy, a nod to traditional Japanese octopus trapping pots whose narrow neck and broad base resemble the distorted shape of a “broken heart”. While broken heart syndrome isn’t exactly what the media has painted it to be, it can be fatal for about 1% of people who experience the syndrome.
But the vast majority do survive…and that’s because the heart is amazingly resilient, says cardiologist and leading authority on broken heart syndrome Ilan S. Wittstein, MD. In fact, some broken-heart syndrome patients can be in the critical care unit on a Wednesday and be ready to go home by that Friday.
Cases of broken heart syndrome tied to emotional strife certainly grab the public’s attention…but it’s actually more common for the condition to be triggered by physical stress such as that created by…
And yet, in about 30% of cases, there’s no obvious trigger.
Regardless of the cause, broken heart syndrome is serious, frightening and requires immediate medical attention. Keep reading to learn more about broken heart syndrome, which Dr. Wittstein and his colleagues first wrote about in 2005 in the New England Journal of Medicine.
Whether you’re reeling from grief or betrayal…were hit by a severe illness…or have just survived a traumatic natural disaster, your body responds by releasing hormones including adrenaline and noradrenaline to help you cope with the stress. In some instances, this flood of hormones interferes with the ability of cardiac cells to beat properly and arteries to direct sufficient blood flow to the heart. This can cause the heart’s main pumping chamber, the left ventricle, to temporarily weaken and enlarge. This “ballooning” of the ventricle is a signature of broken heart syndrome. This all can occur within just minutes or hours after the initial stressor—somebody can pick up the phone, hear bad news and have chest pain within seconds.
Because the symptoms such as chest pain, shortness of breath, nausea and sweating resemble those of a heart attack, broken heart syndrome often is misdiagnosed. A doctor reading a patient’s electrocardiogram (ECG or EKG, a test commonly run in emergency rooms that records the heart’s electrical signals) may not be able to tell the difference between a heart attack and broken heart syndrome. Broken heart syndrome usually isn’t diagnosed until a series of tests are performed including blood work…an ultrasound of the heart called an echocardiogram…and a cardiac catheterization (also called a coronary angiogram), during which a slim tube is fed into a blood vessel in the groin or arm and then threaded into the coronary arteries where released contrast material highlights potential blockages that are viewed on a digital image.
Major difference between a heart attack and broken heart syndrome: Heart attacks typically occur when plaque in a coronary artery ruptures followed by blood clot formation at the site of that rupture. This deprives the heart of blood flow, resulting in the death of that portion of the heart. Patients with broken heart syndrome often don’t have any blockages or clots in their arteries. As a result of the stress hormones, the heart muscle is temporarily stunned but not killed and therefore in time is able to fully recover.
Also: An echocardiogram, which uses sound waves to create images of the heart, can reveal how well the heart is contracting and whether the heart has taken on the telltale takotsubo shape.
Women are at most risk for broken heart syndrome. Risk for women increases five-fold after age 55, and women between ages 65 and 75 make up 90% of all reported cases. Postmenopausal women are by far the most likely to experience broken heart syndrome. Possible reason: Reduced levels of the cardioprotective hormone estrogen may leave older women’s hearts more vulnerable. Other risk factors include preexisting depression or anxiety, both of which disproportionately affect women. The more stressed or anxious an individual is typically, the easier it is for a sudden surge of stress hormones to temporarily stun the heart and trigger broken heart syndrome.
A 2020 Cleveland Clinic study published in Journal of the American Medical Association found that the incidence of broken heart syndrome grew from less than 2% to nearly 8% during the initial months of the COVID-19 outbreak, even though none of the study participants had COVID at the time. Researchers suggested that “psychological, social and economic pandemic-related stress mechanism[s]” were at play. And more recently, research presented at the 2024 Israeli Heart Society/Israeli Cardiology Association Conference showed an almost 100% increase in broken heart syndrome following the events of October 7, when Hamas terrorists waged an attack on Jews in southern Israel.
Anytime you experience a sudden onset of unexplained shortness of breath, chest pain or other heart attack symptoms, call 911. If you’re able to speak, tell your health-care team if you’ve recently experienced any significant stressors, illnesses, injuries or surgeries. They will run the appropriate tests to determine if you have broken heart syndrome and treat you accordingly.
Heart muscle tissue that is damaged during a heart attack dies, but broken heart syndrome does not permanently damage the heart. The heart tissue is only temporarily stunned and can’t contract properly, but it’s not dead. Most patients recover quickly after receiving medical care and improve within days or weeks. The prognosis is especially favorable if the broken heart syndrome was brought on by emotional triggers rather than physical.
Patients who do die typically succumb to whatever physical trigger—high fever, stroke, bleeding, etc.—prompted the broken heart syndrome. Example: When a stroke injures the brain, the brain releases a torrent of stress hormones into the bloodstream, which can stun the heart muscle. In this case, if the patient dies, it’s often from complications of the stroke itself. Treatments of broken heart syndrome consist of supporting the patient’s medical needs—if he/she has low blood pressure or fluid in his lungs, for example, he may require medication or IV diuretics, respectively.
While older women are the most likely to develop broken heart syndrome, they also have the best chances of recovering. While men and younger people are less likely to get the syndrome, their outcomes are typically worse when they get it. This is likely explained by the fact that if you are less susceptible, higher levels of neurohormones are needed to cause the syndrome, and these higher levels result in more serious complications.
There’s not much evidence suggesting that the typical heart-healthy lifestyle habits—exercise, nutrition—will prevent broken heart syndrome or even improve recovery if it strikes.
If you live with high levels of stress or are particularly anxiety-prone, taking steps to reduce tension and worry can help lower your baseline stress level, leaving you less prone to broken heart syndrome. Steps to take…
While it makes sense that intensely unpleasant emotions could stress the body, a small chunk of broken heart syndrome cases are triggered by positive emotions, such as extreme joy. Out of 2,482 cases broken heart syndrome in the multicenter German-Italian-Spanish Takotsubo (GEIST) Registry, 37 were attributed to “Happy Heart Syndrome”—these cases exhibited somewhat similar pathology to broken heart syndrome but were triggered by emotional family celebrations, romantic moments or enjoyable circumstances such as concerts or a first-time meeting with a grandchild. Happy heart syndrome is extremely rare and, unlike broken heart syndrome, more likely to affect men. The prognosis is similar, though—most patients recover and go on to enjoy many more happy moments.
