The Enterprise, Brockton, MA
  • Hersh: Dying of a 'broken heart,' or, takoysubo cardiomyopathy

  • Q: My mom died only a few months after my dad, and the doctor said she may have died of a broken heart. Is there really such a thing?

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    A: Yes, there is a condition called takoysubo cardiomyopathy, also called broken heart syndrome. It is sometimes also called stress cardiomyopathy since it occurs in people under stress, whether emotional or physical stress.
    Broken heart syndrome presents with symptoms just like a heart attack from blocked coronary arteries (by far the most common cause of a heart attack), with the patient typically having chest pain, shortness of breath and/or other classic heart attack symptoms. The initial tests done to evaluate a patient for any heart attack, including an electrocardiogram and specialized heart blood tests, show similar findings for broken heart syndrome as are seen in other causes, so broken heart syndrome is not usually differentiated from other causes of an acute heart attack based on the initial presentation.
    Since heart attacks are unfortunately quite common, in fact heart disease is the number one killer of Americans, patients presenting with signs and symptoms of an acute heart attack are appropriately evaluated and treated for a presumed blockage of one or more of their coronary arteries. Treatment will usually include aspirin and other blood thinning medications, as well as supportive care as needed for insufficient blood being pumped by the heart to supply the body’s vital organs. Furthermore, patients with signs and symptoms of an acute heart attack will often have a cardiac catheterization to evaluate the patency of their coronary arteries (the blood vessels that supply oxygen and glucose to the muscle cells of the heart), and to allow a mechanical intervention to open up any arteries that are found to be acutely blocked (an angioplasty, with or without stent placement).
    When a cardiac catheterization is done in patients subsequently diagnosed with broken heart syndrome, no significant blockage is typically found (although a small piece of plaque breaking off, temporarily causing a blockage and spontaneously clearing is possible). However, high levels of catecholamines (adrenalin-like substances typically secreted in response to stress) have been identified in studies of broken heart syndrome patients, and this is one of the leading theories of how broken heart syndrome develops. Some animal studies have shown that persistent high levels of catecholamines can cause a temporary "ballooning" of the heart, which can lead to a clinical presentation similar to a heart attack as seen in broken heart syndrome. The ballooning can cause the heart to look like a Japanese octopus trap (called a takoysubo), and this reshaping of the heart may be seen on a contrast enhanced echocardiogram in patients with broken heart syndrome.
    Well over a million people have a heart attack every year in the United States, and it is estimated that between one and three percent of these are due to broken heart syndrome. Most of the cases of broken heart syndrome occur in women over the age of 65, although this condition can affect any patient.
    Page 2 of 2 - The diagnosis of broken heart syndrome is suspected after a coronary artery blockage as the cause of the heart attack symptoms is ruled out by showing no significantly clogged arteries on a cardiac catheterization, and is confirmed if the history is consistent with this diagnosis (typically identifying some acute life stressors) and especially if the echocardiography findings show the heart has the classic ballooned shape.
    If the heart failure is severe during the acute phase of broken heart syndrome there can be up to five to 10 percent mortality. However, the heart changes from broken heart syndrome are transient, and the heart returns to normal within several weeks to a month and a half. In fact if the heart does not return to normal after four to six weeks the diagnosis of broken heart syndrome is typically questioned and other causes of the symptoms are suspected and evaluated. Fortunately, recurrence of this condition is not common.
    So stress from the passing of a loved one, or other life stressors (including physical stressors from other illnesses), can cause broken heart syndrome; it is possible to die of a broken heart.
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