Broken Heart Syndrome: Can You Die of a Broken Heart?

Although it may be mistaken for a heart attack, broken heart syndrome is an inflammatory heart disease. The heart muscle weakens, and the apex of the left ventricle swells, constricting blood flow. The left ventricle is the major pumping mechanism of the heart.

(above: left, image of a normal heart; right, a heart affected by BHS)

Medically, BHS is also known as:

• apical ballooning syndrome (ABS)

• tako tsubo cardiomyopathy

• stress cardiomyopathy

Although patients suffering from BHS may need emergency treatment, the heart usually heals within two weeks to two months. Psychological symptoms may persist.

It is possible to die of a broken heart. An extensive study by the Mayo Clinic found a 3.6% fatality rate in patients with broken heart syndrome. The study also found that patients who experienced physical stress had a lower survival rate than those under emotional stress alone.

One in ten people diagnosed with BHS suffered a recurrence within four years.

Symptoms of Broken Heart Syndrome

Physical symptoms may include:

• chest pain and pressure

• shortness of breath

• arrhythmia

• stomach pain, nausea and/or loss of appetite

• fatigue

• insomnia

• in extreme cases – death

Psychological effects of broken heart syndrome may include:

• depression

• constant or frequent crying

• thoughts of suicide

• feelings of emptiness

• the “thousand yard stare”

The “thousand yard stare” is a military term, applied to battle-weary soldiers. In conditions of extreme stress, the gaze may become unfocused, distant and emotionless, indicating a detachment from reality.

BHS is most common in post-menopausal women who have suffered the loss of a loved one or similar intense emotional trauma. A sudden fright, such as a robbery or even a surprise party, can also trigger BHS.

(above: the swollen left ventricle of a BHS patient)

According to Larry Cahalin, a clinical professor at Northeastern University in Boston, broken heart syndrome is “likely under-diagnosed and not completely understood. It mimics a heart attack, in that the heart becomes unable to pump blood to the brain and the rest of the body, with the possibility of life-threatening heart rhythm abnormalities.”

Clinically, BHS differs from a heart attack. The heart of the afflicted person is usually healthy before the onset of symptoms, and the patient often has no history of coronary disease. In broken heart syndrome, the brain releases high levels of catecholamines, primarily adrenaline, norepinephrine and dopamine. Catecholamines are active in the “fight-or-flight” response, and are part of the sympathetic nervous system in humans. The surge of catecholamines weakens the myocardium, or heart muscle, causing heart irregularity, constriction, and changes in the shape of the heart.

Typically, broken heart syndrome involves a significant bulging of the base of the left ventricle. In Japan, where doctors first described BHS as a medical condition in 1991, broken heart syndrome takes the name “tako tsubo” or octopus trap, due to the heart’s resemblance to the structure of an octopus trap.

A study by the Miriam Hospital in Providence, Rhode Island, found that broken heart syndrome occurs most often in the spring or summer months, while cases of cardiac arrest are more common in winter. The study covered a period of four years between 2004 and 2008.

Participants were 75 BHS patients at the Miriam and Rhode Island Hospitals. Twenty percent of the patients had been critically ill with broken heart syndrome, and needed emergency treatment to remain alive. Two-thirds of the participants had suffered severe emotional or physical stress prior to the onset of symptoms.

Diagnosis of Broken Heart Syndrome (BHS)

It is often difficult for emergency room staff to differentiate between BHS and a heart attack. A doctor’s diagnosis of broken heart syndrome may include:

• personal history, including recent stressors such as the death of a loved one, or history of heart disease. Most people with BHS have no previous coronary health problems.

• an electrocardiogram (ECG) detects irregular heart rhythms or structure

• a chest x-ray can show enlargement or abnormal shape of the heart

• an echocardiogram shows details of the structure and function of the heart

• blood tests may detect enzymes specific to broken heart syndrome

Treatment of Broken Heart Syndrome (BHS)

Recovery may involve treatment of physical symptoms, as well as supportive measures such as counseling. Because medical science has only begun to explore the nature of BHS, there are no fixed guidelines for treatment.

Emergency procedures may include the use of a balloon pump to relieve coronary constriction. Standard treatment for heart failure, which addresses blockage of the arteries, is ineffective for broken heart syndrome because the arteries are not blocked.

A course of treatment may include blood pressure medication such as angiotensin-converting enzyme (ACE) inhibitors, beta blockers or diuretics.

Medical research and awareness is essential to the identification and proper treatment of broken heart syndrome.