“Long before the term Broken Heart Syndrome was coined my mother suffered from it! She watched her three year old son hit by a car and killed and many years later she found her oldest son in the bed dead. My mother was grief stricken most of her life; she suffered silently and often had crying spells. I believe the impact of the Broken Heart Syndrome along with the daily stress of racism over the years was the major cause of my Black mother’s death” – Kenny Anderson, Founder of Black Hearts Matter
Broken Heart Syndrome also known as stress-induced 'cardiomyopathy’ or ‘takotsubo cardiomyopathy’, is a condition triggered by an onset of emotional distress. The symptoms of broken heart syndrome are very similar to those of a heart attack, and they can include angina (chest pain), shortness of breath, low blood pressure, and temporary heart failure.
The John Hopkins Heart and Vascular Institute describes stress-induced cardiomyopathy as a condition in which intense emotional or physical stress can cause rapid and severe heart muscle weakness (cardiomyopathy). This condition can occur following a variety of emotional stressors such as grief (e.g., death of a loved one), fear, extreme anger, and surprise. It can also occur following numerous physical stressors to the body such as stroke, seizure, difficulty breathing (such as a flare of asthma or emphysema), or significant bleeding.
Broken Heart Syndrome is more prevalent in postmenopausal women; these women often have a history of emotional or physical stress. Older Black women are at a much greater risk of Broken Heart Syndrome due to a greater accumulation of emotional distress over the years thus being more vulnerable to heart failure. The higher incidences of Broken Heart syndrome among Black women makes them more vulnerable to heart disease and a contributing factor of Black women having the highest heart disease rates in America.
Older Black women have experienced a lot of deaths over the years particular the premature deaths of the Black men in their lives (fathers, brothers, sons, husbands, friends, etc.). Generally older Black women have never had grief counseling and suffer more emotional sadness (depression) from prolonged unresolved ‘compounded grief’.
The most harmful aspect of heartbreak is that it is incredibly stressful, and when we are stressed, our bodies produce an excess of the hormones adrenaline and cortisol. In small doses these hormones raise the heart rate, which is not such a bad thing, but high levels can overwhelm the heart and in some cases actually result in heart failure.
Studies show that emotional distress does indeed affect the physical body in a number of different ways. First of all, emotional pain causes blood to flow to regions of the brain that are also responsible for producing physical pain. This is why many people may feel what psychologists call ‘somatosensory representations’ of pain after a hurtful experience such as rejection. Secondly, heartbreak can interfere with your immune system, which in turn can cause inflammation and a weakening of defenses against illness and infection.
Frequently Asked Questions:
1. What is “Broken Heart Syndrome?”
2. What are the symptoms of stress cardiomyopathy?
Patients with stress cardiomyopathy can have similar symptoms to patients with a heart attack including chest pain, shortness of breath, congestive heart failure, and low blood pressure. Typically these symptoms begin just minutes to hours after the person has been exposed to a severe, and usually unexpected, stress.
3. Is stress cardiomyopathy dangerous?
Stress cardiomyopathy can definitely be life threatening in some cases. Because the syndrome involves severe heart muscle weakness, patients can have congestive heart failure, low blood pressure, shock, and potentially life-threatening heart rhythm abnormalities. The good news is that this condition improves very quickly, so if patients are under the care of physicians familiar with this syndrome, even the most critically ill tend to make a quick and complete recovery.
4. How does sudden stress lead to heart muscle weakness?
First, it is important to understand what “stress” is. “Stress” refers to the body’s response to things it perceives as abnormal. These abnormalities can be physical such as high body temperature, dehydration, or low blood sugar, or can be emotional, such as receiving news that a loved one has passed away. When these abnormalities occur, the body produces various hormones and proteins such as adrenaline and noradrenaline which are meant to help cope with the stress. For example, if a person is suddenly threatened and fears physical harm, the body produces large amounts of adrenaline to help that person either defend himself/herself or run faster to escape the danger. With stress cardiomyopathy, we believe that the heart muscle is overwhelmed by a massive amount of adrenaline that is suddenly produced in response to stress. The precise way in which adrenaline affects the heart is unknown. It may cause narrowing of the 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 which renders them temporarily dysfunctional. Whichever the mechanism, it appears that the effects of adrenaline on the heart in this syndrome are temporary and completely reversible. As will be discussed further in question 5, one of the main features of this syndrome is that the heart is only weakened for a brief period of time and there tends to be no permanent or long-term damage.
5. How does stress cardiomyopathy differ from a heart attack?Stress cardiomyopathy can easily be mistaken for heart attack. Patients with this syndrome can have many of the same symptoms that heart attack patients have including chest pain, shortness of breath, congestive heart failure, and low blood pressure. With a closer look, however, there are some major differences between the two conditions. First, most heart attacks occur due to blockages and blood clots forming in the coronary arteries, the arteries that supply the heart with blood. If these clots cut off the blood supply to the heart for a long enough period of time, heart muscle cells can die, leaving the heart with permanent and irreversible damage. This is completely different from what is seen with stress cardiomyopathy. First, most of the patients with stress cardiomyopathy that both we and others have seen appear to have fairly normal coronary arteries and do not have severe blockages or clots. Secondly, the heart cells of patients with stress cardiomyopathy are “stunned” by the adrenaline and other stress hormones but not killed as they are in heart attack. Fortunately, this stunning gets better very quickly, often within just a few days. So even though a person with stress cardiomyopathy can have severe heart muscle weakness at the time of admission to the hospital, the heart completely recovers within a couple of weeks in most cases and there is no permanent damage.
6. I am under a great deal of stress every day. Is it possible that I have been walking around with stress cardiomyopathy and did not even know it?
While there is no debate that chronic stress can have effects on human health, stress cardiomyopathy appears to be a condition that comes on suddenly and unexpectedly and resolves quite quickly. If you are a person who frequently has symptoms of chest pain or shortness of breath when under significant stress, you should be evaluated by your doctor. He or she may want to perform some basic tests to make sure you are in god health. It is unlikely, however, if your symptoms have been going on for a while that you have stress cardiomyopathy.
7. Who is at risk for getting stress cardiomyopathy?
Because stress cardiomyopathy is a relatively newly appreciated syndrome, we are only beginning to understand why it happens and who is most likely to get it. Most of the patients we have seen with it do not have a previous history of heart disease. It is quite clear from the available medical literature so far, however, that stress cardiomyopathy affects primarily women. In addition, it tends to occur most frequently in middle aged or elderly women (average age about 60). While it can also occur in young women and even in men, the vast majority of the patients we have seen with this are post-menopausal women. The exact reason for this is unknown, and further research will be necessary to help explain this observation.
8. Once a person has had stress cardiomyopathy, will they get it again the next time they are under severe stress.
From what we have seen so far, the answer to this question appears to be no. While it is possible that the syndrome could recur, this is not what we have observed at our hospital. In the five years that we have been following patients with stress cardiomyopathy, none have experienced the syndrome a second time. Further, several of our patients went on to have other stressful events in their lives and none developed the syndrome again.
9. If I have had stress cardiomyopathy, what is my long-term prognosis?
Because the heart muscle is not permanently damaged with this syndrome, patients typically make a rapid and complete recovery. From our experience and from what has been published by other groups, the long-term prognosis for patients with stress cardiomyopathy appears to be excellent.
