Broken heart syndrome

Who is affected by broken heart syndrome?

Takotsubo cardiomyopathy was first described in the 1990s and has since been studied only in small groups of patients. Therefore, there is not yet a large amount of data on which to determine the frequency of the disease. However, broken heart syndrome is observed much more frequently in women than in men. In most cases (over 90 percent) it affects women after menopause (age > 60 years).

While it initially seemed that this form of heart muscle disease occurred mainly in Asia, it has now been observed worldwide .

It is estimated that approximately two percent of all patients and even a good seven percent of women who are admitted to hospital with suspected heart attack (with ST elevation) have broken heart syndrome.

Symptoms

The symptoms of broken heart syndrome are indistinguishable from those of a heart attack. Those affected suffer from shortness of breath, a feeling of tightness in the chest and sometimes even severe pain there, which is also known as excruciating pain.

Blood Pressure

Blood pressure often drops (hypotension), the heart rate increases (tachycardia), and sweating, nausea and vomiting occur. Due to the limited function of the heart, symptoms of heart failure are also common. For example, blood backs up in the lungs and venous vessels because the heart can no longer pump it sufficiently into the circulation. This can result in fluid accumulation (edema) in the lungs and legs. These symptoms often trigger a fear of death.

Complications

Although the mechanism that leads to the symptoms is completely different from that of a heart attack, broken heart syndrome can also be associated with serious, sometimes life-threatening complications. For example, a small proportion of those affected experience severe cardiac arrhythmias , which in the worst case can lead to sudden cardiac death.

If the heart’s pumping capacity is severely weakened, a condition known as cardiogenic shock can also occur. Blood pressure then drops so much that the body is no longer supplied with enough oxygen. Without timely treatment, this complication is often fatal.

Causes and Risk Factors

In the vast majority of cases, broken heart syndrome is preceded by a great deal of emotional stress. This could be, for example, a separation from a life partner or the death of a loved one, which explains the name of the illness.

Traumatic events such as natural disasters or violent crimes as well as life-threatening situations (e.g. loss of a job) can also cause broken heart syndrome.

Recent studies have also shown that positive stress can also trigger Takotsubo cardiomyopathy. Happy events such as a wedding, a birthday or winning the lottery are also possible reasons for this form of heart muscle disease, although much less common than negative stress.

Genetic predisposition conceivable

Researchers now also believe that there may be a genetic predisposition to broken heart syndrome. The genetic changes examined also affect other diseases such as cancer and obesity. Genes for blood pressure and thyroid function were particularly altered.

Increased levels of stress hormones

How exactly emotional stress leads to dysfunction of the heart muscle and the physical symptoms of a heart attack is not yet fully understood. However, many patients with broken heart syndrome have increased levels of certain stress hormones in their blood. For example, so-called catecholamines such as adrenaline and noradrenaline are released in increased amounts by the body of those affected. Researchers suspect that the stress hormones affect the heart muscle and lead to circulatory problems and cramps.

There is also a tumor that secretes these stress hormones – the so-called pheochromocytoma. This usually benign tumor of the adrenal gland produces catecholamines. The increased stress hormone level can damage the heart.

Reduced Estrogen levels

Female sex hormones (estrogens ) have a protective effect on the heart. Since their concentration in the blood decreases after menopause, this is a possible explanation for why older women are particularly affected by broken heart syndrome.

Examinations and Diagnosis

Because of the similar symptoms, doctors who suspect broken heart syndrome carry out the same tests as those who suspect a heart attack. The aim is to rule out the more life-threatening heart attack as early as possible. Broken heart syndrome shows many similar results in studies, but also has crucial differences:

Echocardiography

In an ultrasound examination of the heart (echocardiography ), the typical movement disorders of the left ventricle can usually be seen in broken heart syndrome, mostly in the area of ​​the apex of the heart. The muscles there are very little mobile (akinesia) and appear bloated. This is how the alternative name for the disease came about:

At the end of the heartbeat (systole), the heart looks like a jug with a short neck. This shape is reminiscent of a Japanese octopus trap called “Tako-Tsubo”.

As a result of the heart failure that often results, echocardiography can also often detect fluid accumulation in the lungs ( pulmonary edema).

A heart attack can present itself in a similar way and therefore cannot be ruled out based on echocardiography alone.

Electrocardiography

The ECG curve in stress cardiomyopathy also resembles a heart attack. There are changes in the electrical activity of the heart, which are typical for a lack of oxygen to the heart muscle.

However, these changes usually appear in all curves (leads) of the ECG and not just for a specific area of ​​the heart muscle, as is generally the case with a heart attack.

Blood Values

As with a heart attack, in broken heart syndrome the concentrations of certain enzymes such as troponin T or creatine kinase (CK-MB) in the blood increase after a few hours. However, the increases are usually smaller than in a heart attack and do not match the otherwise pronounced results of the cardiac ultrasound and ECG.

Angiography

Angiography can be used to visualize whether and how well the various coronary arteries are supplied with blood. While one or more coronary arteries are blocked in a heart attack, Takotsubo syndrome does not involve a blockage of a coronary artery. Angiography is therefore a good method of distinguishing between the two diseases.

Doctors usually perform angiography as part of a cardiac catheter examination. In principle, however, the coronary arteries can also be visualized using magnetic resonance imaging (MRI) or computed tomography (CT) – supported by the administration of a contrast agent, as in conventional angiography.

Patient Consultation

When speaking to patients with acute heart problems to take their medical history (anamnesis), doctors are particularly interested in whether the event was preceded by an intense emotional stress situation, in addition to the symptoms. If this is not the case, broken heart syndrome is unlikely.

You have to be careful here, because stress can also lead to a heart attack.

Other diseases with similar symptoms (differential diagnoses) that must be ruled out if broken heart syndrome is suspected include, in addition to a heart attack , pulmonary embolism , stomach ulcer and vertebral fracture.

Treatment

There is currently no standardized treatment plan for Takotsubo cardiomyopathy. Because life-threatening complications can occur, especially in the first few hours, patients are monitored in an intensive care unit for some time. The effect of stress hormones and in particular the increased activity of the stimulating sympathetic nervous system (a part of the autonomic nervous system ) can be reduced with certain medications such as beta-blockers. These drugs reduce the strain on the heart.

Cardiac arrhythmias and any symptoms of heart failure can also be treated with appropriate medication.

Course of the Disease and Prognosis

Of all heart muscle diseases, Tako-Tsubo cardiomyopathy has the best prognosis. The symptoms often disappear within the first few hours. Permanent damage to the heart is rare. However, if you are predisposed to it, the risk of recurring stress cardiomyopathy is around ten percent. In most patients, heart function returns to normal after a few weeks without stress. The broken heart syndrome then heals without any further consequences.

In the UAE

Broken heart syndrome (takotsubo cardiomyopathy) is relevant to people in the UAE because:

1. High-Stress Lifestyle – Many residents face high work pressure, financial stress, or expatriate-related challenges that can trigger the condition.
2. Advanced Healthcare – The UAE offers specialized cardiology clinics, such as those in Dubai and Abu Dhabi, providing diagnosis and treatment.
3. Heart Health Awareness – Raising awareness can help people recognize symptoms (chest pain, shortness of breath) and seek timely medical help.
4. Cultural and Emotional Factors – Loss, grief, and emotional distress in a diverse expat population can contribute to cases.

If you live in the UAE and experience sudden chest pain after emotional stress, seeking urgent medical attention can be life saving.