Stress Can Lead to Broken Heart Syndrome

We often find ourselves missing loved ones that have passed on, or allow ourselves to become overly stressed. But no one has ever actually died of a broken heart or too much stress, have they?

Actually, some have come very close as the result of a condition called Takotsubo Cardiomyopathy, also known as Takotsubo Syndrome or Stress Cardiomyopathy.

Takotsubo Cardiomyopathy is still relatively rare, but 10% of the women admitted to the hospital with typical symptoms of a heart attack have Takotsubo.

Today’s Straight Talk is a letter from Dr. Paolo Angelini to inform you about the ins and outs of Takotsubo.

Until next time!

Stephanie Coulter, MD

Symptoms of broken heart syndrome

Some people who experience sudden or prolonged periods of stress may develop a condition that feels very similar to a heart attack. In reality, they may have “broken heart syndrome” which is clinically referred to as Takotsubo Cardiomyopathy.

Symptoms of this syndrome include:

• Chest pain
• Shortness of breath
• Weakness
• Cold sweating
• Irregular heart beat

Because symptoms are so similar to those of a heart attack, physicians may have difficulty diagnosing a patient correctly without the proper tests.

Women at greatest risk

Women are at greater risk for experiencing Takotsubo Cardiomyopathy than men. In fact, women are seven to nine times more likely to suffer from broken heart syndrome. Most victims are postmenopausal women above 50 years of age.

Examples of triggers for the syndrome include:

• Times of prolonged stress
• Death of a loved one
• Recent life changes, such as loss of a job
• End of a relationship
• Physical stressor, such as an asthma attack, surgery or a car accident
• Being surprised
• Natural disasters like earthquakes and hurricanes

I had one patient, a postmenopausal woman, who had a severe asthma attack while she was in the middle of remodeling her home. After taking an extra dose of bronchial asthma inhaler, she developed chest pain, worsening shortness of breath, and she collapsed. She had been checked before for similar symptoms by traditional methods designed to identify blockages and none were found. This time, because she was so sick, she was admitted to the hospital. There she learned that her heart was so weak that she could have qualified for a heart transplant. This is a perfect example of how Takotsubo can behave.

It’s not a heart attack

Although symptoms are similar, Takotsubo Cardiomyopathy is not a heart attack. What makes it different is that medical tests will confirm there are no blockages in the coronary arteries. My group and I have found evidence that the condition of Takotsubo is related to sudden and temporary narrowing of the coronary arteries. This causes the coronary arteries to spasm, resulting in part of the heart temporarily enlarging and pumping inefficiently. We can actually reproduce the symptoms by inducing the heart to spasm using a drug called acetylcholine.

Get help

Even though Takotsubo Cardiomyopathy is normally temporary, it can cause permanent complications, and in 2% of cases, it is deadly. All victims of Takotsubo need treatment and a preventive plan needs to be established.

Should you experience symptoms similar to the ones described, especially if you also suffered a sudden upset of any kind, it is important that you call 911 immediately.

I realize that many women may be reluctant to call 911. Many may decide to put it off due to a busy schedule or fear being seen as silly or overreacting. Don’t ignore symptoms like chest pain, shortness of breath, irregular heartbeat, or general weakness. Get help.

Scientific Literature on Takotsubo

1. Angelini P: Transient left ventricular apical ballooning: A unifying pathophysiologic theory at the edge of Prinzmetal angina. Catheter Cardiovasc Interv. 2008 Feb 15; 71(3):342-52

2. Angelini P: Re: Stress (Takotsubo) cardiomyopathy—a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nat Clin Pract Cardiovasc Med. 2008 Jun;5(6):E1;

3. Angelini P: Tako Tsubo, where everything can be variable: or can it? The quest for solid grounds in a slippery entity. Europace. 2008 Dec;10(12):1359-60. Epub 2008 Oct 9

4. Angelini P: Midventricular variant of transient apical ballooning: a likely demonstration of its pathophysiologic mechanism.  Mayo Clin proc. 2009;84(1): 92-3

5. Angelini P: Takotsubo cardiomyopathy: what is behind the octopus trap? Tex Heart Inst J. 2010;37(1):85-7

6. Angelini P. Reverse, or inverted, transient Takotsubo cardiomyopathy: terms and status of an open discussion. Tex Heart Inst J. 2013;40(1):60-3

7. Angelini P, Monge J, Simpson L. Biventricular takotsubo cardiomyopathy: case report and general discussion. Tex Heart Inst J. 2013;40(3):312-5.

8. Angelini P, Tobis JM. Is high-dose catecholamine administration in small animals an appropriate model for takotsubo syndrome? Circ J. 2015 Mar 25;79(4):897.

9. Angelini P, Uribe C. Cardiac Arrest in Takotsubo Cardiomyopathy. Am J Cardiol. 2015 Aug 1;116(3):489-90.

10. Angelini P. Do pathologists agree on how to diagnose takotsubo cardiomyopathy? Forensic Sci Med Pathol. 2016 Jun;12(2):226. doi: 10.1007/s12024-015-9739-8

11. Paolo Angelini, Carlo Uribe, Jonathan M. Tobis; Pathophysiology of Takotsubo Cardiomyopathy: Reopened Debate. Tex Heart Inst J 1 July 2021; 48 (3): e207490. doi: 10.14503/THIJ-20-7490