Broken Heart Syndrome

By: Andreea-Maria Chiriță

Broken Heart Syndrome, also known as Takotsubo Syndrome (TS), is a sudden and transient dysfunction of the left and/or right ventricle which often mimics Acute Coronary Syndrome (ACS). Broken heart syndrome is a condition that can cause rapid and reversive heart muscle weakness, also known as stress cardiomyopathy. 

Japan was the first country to describe this syndrome in the 1990s and, since then, it has received a lot of attention from researchers all around the world. Although TS was once thought to be a harmless condition, recent evidence suggests that it may be linked to serious complications and mortality on par with Acute Coronary Syndrome (ACS). The understanding of TS has evolved over the past few years. However, its exact etiology is still poorly understood. 

It can be classified into two main types: Primary and Secondary TS. 

● Primary TS occurs when the symptoms of myocardial damage, which are typically preceded by emotional stress, are the reason for hospitalization. 

● Secondary TS is seen in patients hospitalized for some other medical, surgical, obstetric, anesthetic, or psychiatric conditions and the dysfunction develops as a secondary complication due to the activation of the sympathetic nervous system and the release of catecholamines 

The name of the condition ‘Takotsubo’ is derived from the characteristic ‘ballooning’ similar to a Japanese octopus trap. In 1990 and 1991, Sato and Dote coined the term “Takotsubo” (tako = octopus, tsubo = a pot), to describe the left ventricular silhouette during systole in five patients with clinical features of myocardial infarction, but no obstructive coronary artery disease. More recently, atypical forms of this condition involving hypokinesia of the basal segment and various other types of wall motion abnormalities have been described. 

The role of stressors 

Despite the ambiguity in the pathogenesis of TS, the current evidence agrees upon the impact of stressors in causing TS. Sudden somatic and/or emotional stress causes a rise in the levels of catecholamine, resulting in transient left ventricular dysfunction. 

Stressors can be further classified into two groups: physical and emotional stresses; although the various triggering events recorded to date are diverse. A study showed that in patients with TS, about 39% experienced a triggering emotional stressor, whereas 35% experienced a physical stressor. Somatic or physical stressors researched to precede TS are vigorous exercise, hyperthyroidism, alcohol/opiate withdrawal postoperative pain, etc.

Emotional Stressors 

Emotional stressors include: 

● Grief 

● Fear 

● Extreme anger 

● Surprise 

● Physical Stressors 

These conditions include: 

● High fever 

● Stroke 

● Seizure 

● Difficulty breathing (such as an asthma attack or emphysema) 

● Significant bleeding 

● Low blood sugar 

What are the symptoms of broken heart syndrome? 

The symptoms of broken heart syndrome can mimic symptoms of a heart attack, including: 

● Chest pain 

● Shortness of breath 

● Diaphoresis (sweating) 

● Dizziness 

● 

These symptoms may begin as soon as minutes or as long as hours after an emotionally or physically stressful event. 

How does sudden stress lead to heart muscle weakness? 

When you experience a stressful event, your body produces hormones and proteins such as adrenaline and noradrenaline, that are meant to help cope with the stress. 

The heart muscle can be overwhelmed by a massive amount of adrenaline that is suddenly produced in response to stress. Excess adrenaline can cause narrowing of the small arteries that supply the heart with blood, causing a temporary decrease in blood flow to the heart. 

Alternatively, the adrenaline may bind to the heart cells directly, causing large amounts of calcium to enter the cells. This large intake of calcium can prevent the heart cells from beating properly. It appears that adrenaline’s effects on the heart during broken heart syndrome are temporary and completely reversible — the heart typically recovers fully within days or weeks.

Is broken heart syndrome dangerous? 

Broken heart syndrome can be life-threatening. In some cases, it can cause severe heart muscle weakness resulting in: 

● Congestive heart failure 

● Low blood pressure 

● Shock 

● Potentially life-threatening heart rhythm abnormalities 

● 

The good news is that this condition can improve very quickly if patients are under the care of doctors familiar with the syndrome. Even people who are critically ill with this condition tend to recover. 

How does broken heart syndrome differ from a heart attack? 

Most heart attacks occur due to blockages and blood clots forming in the coronary arteries, which supply the heart with blood. If these clots cut off the blood supply to the heart for a long enough time, heart muscle cells will die, leaving the heart with scar tissue and irreversible damage. 

People experiencing broken heart syndrome frequently have normal coronary arteries and often do not have severe blockages or clots. The heart cells of people experiencing broken heart syndrome are stunned by the adrenaline and other stress hormones. Fortunately, this gets better very quickly in most cases, often within weeks or just a few days. Most patients don’t have scar tissue or damage. 

If someone is diagnosed with broken heart syndrome, what treatment should they receive? 

It is important to follow up with a cardiologist who is familiar with this syndrome and who can tell them when their heart muscle has fully recovered. Early on, the cardiologist may want to treat them with standard medications for heart muscle weakness, but this will depend on several factors, including their heart rate and blood pressure. 

The doctor may suggest an exercise program including cardiac rehabilitation. Avoiding stressful situations if possible is always recommended, and interventions to reduce stress such as biofeedback, meditation, yoga, physical rehabilitation, and exercise can be very helpful to some patients with this syndrome. 

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References 

Ilan Shor Wittstein, M.D. (n.d.). “Broken Heart Syndrome”. Retrieved 5 February, 2025, from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/broken-heart-syndrome#:~:tex t=What%20causes%20broken%20heart%20syndrome,time%20of%20their%20initial%20sym ptoms 

Yashendra Sethi, Hamsa Murli, Oroshay Kaiwan, Vidhi Vora, Pratik Agarwal, Hitesh Chopra, Inderbir Padda, Manasa Kanithi, Mihaela Simona Popoviciu, Simona Cavalu (24 December, 2022),

"Broken Heart Syndrome: Evolving Molecular. Mechanisms and Principles of Management". Retrieved 5 February 2025, from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9821117/?utm_source=chatgpt.com#B11-jcm-12-00125 

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