Broken Heart Syndrome: Treatment and Prevention

‘Broken heart’ is often related to a ‘heartbreak’. But did you know that it is a medical condition? Yes, this is called broken heart syndrome, which is manifested as a result of intense emotional or physical stress and can lead to rapid and severe heart muscle weakness.

The exact cause of broken heart syndrome is not fully understood but is thought to be related to a surge of stress hormones.More than 90% of reported cases are in women ages 58 to 75, and research suggests that up to 5% of women suspected of having a heart attack have this disorder.

Read on to conceive this condition, its diagnosis, symptoms, causes, and treatment below.

What is broken heart syndrome?

Broken heart syndrome was described first in 1990 in Japan. Alternatively termed stress cardiomyopathy, takotsubo cardiomyopathy, or apical ballooning syndrome, it is the weakening of the left ventricle, the heart's main pumping chamber, due to an emotionally stressful event in life. It often mimics the symptoms of a heart attack, such as chest pain and shortness of breath, but is not due to clogged arteries. It is associated with no long-term heart damage and mostly recovers over time.

Types of broken heart syndrome

Broken heart syndrome can manifest in different patterns in different people. Several types have been identified based on the location and extent of heart muscle involvement.

The four different types of broken heart syndrome are:

Apical Ballooning (Classic Type):

• More than 80% of cases come under the apical ballooning category.
• It affects the lower half of your heart, the apex (tip) of the left ventricle.
• In this condition, during systole (cardiac contraction), the left ventricle’s midsection and tip (apex) balloon out, while the area above, called the base, contracts as usual.
• It is also called takotsubo cardiomyopathy as the shape is similar to that of a tako-tsubo, a round-bottomed, narrow-necked vessel used to catch octopuses.

Midventricular Ballooning:

• This condition affects the middle section of the heart’s lower chambers/ ventricles and looks like a belt or ring around the heart.
• The apex and base of the heart may contract normally, while the middle part balloons out.

Basal Ballooning:

• This type affects the base of the left ventricle, and it looks like a ring or belt.
• The area below the belt functions normally.
• It is a rare condition and makes up about 2% of cases.

Focal Ballooning:

• It is of the rarest type, making up about 1% of cases.
• It affects a much smaller area of the heart, forming a bulge that sticks out noticeably from the rest part.
• The opposite side of the heart curves inward toward the bulge.

What causes broken heart syndrome?

• Though the exact reason for broken heart syndrome is not known, it is believed to be the result of reaction to physical or emotional stress in the body.
• No evidence suggests that a parent can pass it down to their children.

Some potential triggers and broken heart syndrome causes include:

Emotional Stress:

• Intense emotional experiences, like sudden illness such as COVID-19, death of a loved one, strong argument, and domestic violence can trigger stress hormone production.
• Experts reckon these hormones temporarily interfere with the heart’s function.

Physical Stress:

• Serious physical illnesses, surgeries, accidents, and amputation can induce the production of stress hormones in the body.
• Asthma attacks and other respiratory issues also induce physical stress in the body.

Hormonal Factors:

• The stress causes the body to release stress hormones such as adrenaline (epinephrine) and cortisol in the blood that might damage the heart for a short time.
• It temporarily curbs the heart’s ability to pump well or ‘stuns’ the heart and the left ventricle temporarily weakens and stops pumping well.

Coronary Artery Spasms:

• The coronary arteries supply oxygen to the heart muscle, spasm causing chest pain.
• These spasms prevent the left ventricle from contracting effectively.

Other causes:

• Rarely, the use of certain medicines or illegal drugs may lead to broken heart syndrome symptoms.
• According to the Mayo Clinic, some emergency medicines used to treat severe allergic reactions or severe asthma attacks, anxiety, stuffy nose etc. may induce such conditions in few.
• Illegal stimulant drugs, such as methamphetamine and cocaine are top contenders in the contributing factors list.

What are the symptoms of broken heart syndrome?

• The broken heart syndrome symptoms typically manifest similarly to heart attack symptoms, often leading to a dilemma.  
• The most common signs are chest pain and shortness of breath.
• It can arise within minutes up to hours after a stressful event.
• Takotsubo cardiomyopathy can produce the same sudden heart attack symptoms even when the coronary arteries are clear.

Chest Pain or Discomfort:

• The most common symptoms are tightness, pressure, or squeezing sensation in the chest.
• This pain is typically located in the chest area and may radiate to the neck, jaw, shoulder, or arm, mimicking a heart attack.

Shortness of Breath:

• Difficulty breathing or a feeling of breathlessness may occur.
• This symptom can be severe and may be accompanied by fatigue, cold sweats, or lightheadedness.

Irregular Heartbeat (Arrhythmias):

• Sometimes the heart may be beating too fast when at rest just not beating in a regular pattern or may be too slow. This is called cardiac arrhythmia.
• People with Broken Heart Syndrome may experience irregular heartbeats (arrhythmias).

Other causes:

• Extreme tiredness or fatigue
• Nausea or vomiting
• Low blood pressure (hypotension)
• Fainting (syncope)
• Excessive sweating even when not physically active.

What are the complications of broken heart syndrome?

Broken heart syndrome death is rare and most people recover fully without any long-term effects. Most individuals who experience it recover fully within two months and are at low risk of it happening again.

Broken heart syndrome complications are rare, but may include:

Heart Failure:

• Here the heart's pumping function may be significantly impaired, leading to heart failure or congestive heart failure.
• When the heart cannot pump effectively, blood builds up in other parts of the body and gets collected in the lungs, legs and feet.

Arrhythmias:

• Variations in the normal heartbeat such as palpitations, rapid heart rate, or other disturbances in the heart's rhythm are cardiac arrhythmia.
• This condition is one of the main broken heart syndrome symptoms.

Other complications:

• Heart valve damage
• Cardiogenic shock
• Low blood pressure
• Fluid backing up into lungs
• Blood clot in the wall of the left ventricle

Appropriate medical care, including close monitoring and management of potential complications, is essential for Broken heart syndrome treatment. Persistent signs, consistent with heart failure, can be fatal in rare cases.

How is broken heart syndrome diagnosed?

Broken Heart Syndrome diagnosis involves a combination of evaluation of the patient’s medical history, physical examination, and various diagnostic tests to rule out other potential causes of symptoms.

As the Broken Heart Syndrome symptoms are often comparable to a heart attack, it is crucial to do the following tests:

Physical exam and history

• The doctor’s introductory query will be about any major events or physical or emotional stress that might have occurred recently in your life.
• The doctor will also assess vital signs, listen to the heart and lungs, and check for signs of heart failure or other cardiac issues.

Electrocardiogram (ECG)

• An electrocardiogram measures the electrical activity of the heart. Sticky patches called electrodes are placed on the chest. Wires connect the electrodes to a computer, which shows the test results.
• By analysing the ECG, the doctor can infer if there is any problem with the heart's rhythm and structure and check if it is from a heart attack.

Coronary angiogram

• CAG or coronary angiogram involves injecting contrast dye into the coronary arteries and taking X-ray images to visualize blood flow/ if there are any blockages to rule out coronary artery disease.
• People with heart attacks will have visible blockages and thus the broken heart syndrome symptoms are disassociated from heart attacks.

Echocardiogram

• It is a key diagnostic tool in which the ultrasound shows the doctor if you have an enlarged heart or abnormalities in the shape and movement of the heart muscle while it pumps, helping to differentiate Broken Heart Syndrome from other cardiac conditions.
• The detailed images of the heart's structure and function help the doctors in the broken heart syndrome treatment.

Blood tests

• These blood tests check for a specific enzyme from damaged heart muscle cells.
• People who have broken heart syndrome often have higher levels of substances called cardiac enzymes in the blood.

Chest X-ray

• A chest X-ray can help the doctor to analyze the images of the heart if it is an enlarged heart or has an abnormal shape.
• It can also be ordered to rule out the possibility of respiratory issues that may cause similar symptoms.

Other tests like Radionuclide perfusion imaging or Cardiac MRI may be done to get detailed images of the heart for confirmation to rule out other conditions and start the broken heart syndrome treatment.

What is the treatment for broken heart syndrome?

Broken heart syndrome treatment involves managing symptoms, supporting heart function, and addressing potential complications. Patients may be advised to get hospitalized and until the diagnosis is clear, the symptomatic treatment is mainly a heart attack treatment.

The medical care and treatment plan may include:

Hospitalization

• Hospitalization is mainly advised to the patients to do the diagnostic tests to confirm the broken heart syndrome by ruling out any possibilities of heart function abnormalities.
• Continuous monitoring of heart function through electrocardiograms (ECGs), echocardiograms, or other imaging studies ensures no complications arise.
• Most people stay in the hospital for proper monitoring and supportive care, until they get better.

Medications

• For broken heart syndrome treatment, the doctor will prescribe medicines used to treat heart failure or reduce the strain on the heart.
• Medicines also can help prevent further episodes of broken heart syndrome.
• Standard heart failure medications such as ACE inhibitors, Angiotensin II receptor blockers (ARBs) to lower blood pressure and fight inflammation, Beta-blockers to slow your heart rate, Diuretics (water pills) to alleviate fluid buildup in the lungs and other tissues, Anti-anxiety medication and Blood thinners if there is a blood clot, are generally prescribed.
• These medications help reduce the effects of stress hormones on the heart and can alleviate symptoms.

Complications/side effects of treatment:

• Broken heart syndrome treatment is usually symptomatic and involves the administration of a variety of drugs based on the experienced symptoms and diagnostic test results.
• It can cause allergic or negative reactions to the medications or interactions between medications and other drugs you take.
• Bleeding, infections, blood clots, stroke or a heart attack from a left ventricular assist device or intra-aortic balloon pump may be possible if used.

Following the prescribed broken heart syndrome treatment plan, attending follow-up appointments, and making necessary lifestyle changes are key components of recovery.

How to recover from broken heart syndrome?

How to recover from broken heart syndrome- it mainly depends on a combination of medical treatment, supportive care, and lifestyle adjustments.

Some of the decisive elements of the recovery from this syndrome include:

• Ensure proper medical attention is received and comply with the diagnostic procedures that can rule out other heart issues and the healthcare provider can start the broken heart syndrome treatment.
• Regular intake of medications as prescribed by the doctor and attending follow-up appointments for regular monitoring of heart function is of utmost importance. Your doctor may order a test, such as an echocardiogram, after 6 weeks, to see if your heart has improved.
• It is best to follow any recommendations or restrictions provided by the healthcare team for proper recovery.
• If emotional distress is the trigger, consider getting therapy from a mental health professional. Joining a support group or talking to others who have experienced similar challenges will empower you to deal with things better.
• Engage in stress management techniques such as deep breathing exercises, meditation, yoga, or mindfulness to help reduce stress levels.
• Make lifestyle changes with a proper diet, exercise, sleep, work-life balance etc. to manage the heart health and overall health of the body.
• Sometimes, broken heart syndrome happens again after treatment. So do regular follow-ups and communicate new or worsening symptoms with your healthcare provider promptly.

Can broken heart syndrome be prevented?

Emotional and physical stress in the body are the known broken heart syndrome causes. Let us check a few pointers on how to prevent broken heart syndrome.

• Learning stress management and problem-solving techniques may help in keeping the heart health good.
• Practicing yoga, meditation, journaling or mindfulness, taking a warm bath, lighting scented candles, taking long, breathing exercises and any other hobby which you like can help you relax and destress.
• Eat a well-balanced diet and include foods good for heart health in your daily diet.
• Get regular exercise at least five times a week for 30 minutes.
• Schedule your sleep so you get seven to nine hours each night.
• Socializing, joining a support group etc. can help in relaxing.
• Checkups and screenings as per schedule are a must.
• Avoid tobacco product use, recreational drug use and excessive alcohol use. These are bad for heart health and overall health as well.

Conclusion

Broken Heart Syndrome, medically known as stress-induced cardiomyopathy or takotsubo cardiomyopathy, can manifest symptoms similar to a heart attack, such as chest pain, shortness of breath, and sometimes, fainting. The condition is common in postmenopausal women, but it can affect individuals of any age or gender.

The best approach to treatment and prevention may vary from person to person, and consultation with healthcare professionals is essential for personalized guidance. For Broken Heart Syndrome treatment, seeking prompt medical attention is crucial for accurate diagnosis and appropriate care.

Although not fatal, finding out the trigger and practicing relaxation techniques, lifestyle changes and following up with the medical professional's advice is crucial for addressing potential complications.