Broken Heart Syndrome

Earlier this year, we published a piece on the effects that significant emotional stress can have on the heart – the so-called Takotsubo cardiomyopathy (also called stress induced cardiomyopathy, apical ballooning syndrome, or even broken heart syndrome).

In simple terms, the condition is a transient weakening of the heart muscles, usually (but not always) triggered by some form of physical or emotional stress. This stress results in the release of a collection of chemicals (like adrenaline) that then cause damage to the heart and weaken its ability to pump – causing heart failure.

Here, we’ll talk a little more about the condition – what we know and what we don’t.

The term takotsubo refers to a Japanese octopus pot, with a characteristic shape where the tip of the pot appears ballooned out, and the base has a narrow neck – this name was given to the condition as the heart fails in a very specific pattern – the tip of the heart balloons out and stops working, whereas the base of the heart works overtime to compensate.

Ventriculogram of Takatsubo cardiomyopathy and the Japanese octopus trap for which it is named.

The syndrome was first described in 1990 in the Japanese texts, however even back in the 80s there were descriptions of microscopic heart damage following traumatic injuries, despite there being no obvious injury to the heart. Even 25 years later, we still have a limited understanding of the condition.

What we know about broken heart syndrome:

• the dysfunction of the heart is usually transient
• there is often an emotional or physical trigger – but over a quarter have no obvious trigger at all
• it can mimic a heart attack (can feel like one, and even look like one on some of the tests)
• there are different forms affecting different parts of the heart
• there is a strong association with neurological or psychiatric disorders
• in the Western world, it is more common in elderly females (although in Japan, it is more common in men)
• it can recur, even years later
• it is not completely benign – like a heart attack, there can be complications such as a dangerous heart rhythm
• about three quarters of people present with chest pain
• most people recover heart function within four weeks

What we don’t know about broken heart syndrome:

• why exactly it happens – the running theories include spasm of the blood vessels around the heart, along with microscopic dysfunction and direct damage from the stress related chemicals
• why certain groups are more affected
• how to prevent recurrence

How we diagnose broken heart syndrome:

Up front, it’s not always an easy to diagnose, because the condition can appear very similar to a heart attack – with changes to your electrocardiogram (ECG or EKG) and to the blood tests (troponin), we must perform a coronary angiogram to exclude any blockages in the heart arteries to confirm that it is indeed Takotsubo. Sometimes the echocardiogram (ultrasound of the heart) can give us a characteristic appearance, but the angiogram is necessary to confirm that there is no problem with the plumbing.

How we treat broken heart syndrome:

Medications are focused on helping the heart to pump – similar to what we use in heart failure – and specifically angiotensin-converting-enzyme inhibitors (ACE inhibitors) have been shown to be beneficial. These don’t necessary continue forever, as the condition is transient, however there is no good information about how long they should continue for.

Although Takotsubo is becoming increasingly recognised, right now, if you get chest pain there is no doubt – don’t assume it’s this – call an ambulance and get yourself to hospital.