Broken Heart Syndrome: Stress Really Can Break Your Heart

Facing a divorce or a loved one’s death can cause you to feel heartbroken. Severe emotional stress can also cause real heart damage — broken heart syndrome.

It’s no surprise being frightened or experiencing anxiety over something you dread doing can make your heart pound, possibly trigger palpitations, and raise your blood pressure, too. These are common and normal physiological responses to stress which, thankfully, usually pass fairly quickly. But one form of severe emotional stress caused by a sudden shock can cause the cardiovascular system to be more seriously affected. The result can be Takotsubo syndrome (TTS), better known as broken heart syndrome.

In the most serious cases, broken heart syndrome is a tragic example of how the mind and emotions can wreak havoc with the heart. Tragically, when someone says they feel like they are “dying from a broken heart” because of their suffering after a personal loss, that statement can sometimes be true.

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Broken heart syndrome risks and symptoms

In 1990, Japanese scientists were the first to identify TTS, also identified as takotsubo cardiomyopathy. This potentially fatal condition, most often called broken heart syndrome, is triggered by sudden, extreme stress. For example, it can develop within hours after a person learns a spouse or child has died. Severe physical stress, such as being lost in rugged terrain or enduring a lengthy combat situation, can also cause TTS.

Researchers believe that broken heart syndrome rapidly damages the heart because stress hormones flood into the body during times of intense shock. Even in people who are perfectly healthy, this can stun and weaken the heart muscle. One of the heart’s lower chambers, the left ventricle, then balloons outwards. The resulting symptoms can include chest pain, low blood pressure, shortness of breath, potentially fatal abnormal heart rhythms, and rapidly developing heart failure.

There is good news is about broken heart syndrome. The condition is often temporary. It can be usually be treated, and most people respond well and recover from TTS very quickly, often within several weeks.

That’s why it’s important to talk to you doctor if you have experienced a severe shock and are not feeling well. Never ignore any physical symptoms after a particularly stressful time in your life because, although it’s rare, people can die from broken heart syndrome, according to the American Heart Association.

The brain and heart connection in broken heart syndrome

Scientists at Harvard-affiliated Massachusetts General Hospital (MGH) have uncovered more clues about exactly how broken heart syndrome develops. A study by the MGH researchers, published in the European Heart Journal, found a strong link between how individuals’ brains respond to stress and whether or not they are likely to develop broken heart syndrome.

Some people appear to be “primed” to develop TTS, and they can develop broken heart syndrome after stressful events that some people might not consider very stressful at all. What’s more, the stress may not involve the typical heartbreaking event most patients who develop broken heart syndrome report.

For their research, the investigators analyzed brain imaging scans from 104 patients who had undergone the tests for medical reasons not connected to broken heart syndrome. The goal was to document whether the people with scans that showed increased stress-associated metabolic brain activity had been more likely to eventually develop TTS. In all, 41 of the research subjects had developed TTS and 63 had not. The researchers found a strong link between those people whose brain scans showed a heightened brain activity associated with stress and broken heart syndrome occurrence.

“Areas of the brain that have higher metabolic activity tend to be in greater use (in people who develop TTS). Hence, higher activity in the stress-associated centers of the brain suggests that the individual has a more active response to stress,” explained senior author Ahmed Tawakol, MD, director of Nuclear Cardiology and co-director of the Cardiovascular Imaging Research Center at MGH.

“We show that TTS happens not only because one encounters a rare, dreadfully disturbing event — such as the death of a spouse or child, as the classical examples have it. Rather, individuals with high stress-related brain activity appear to be primed to develop TTS and can develop the syndrome upon exposure to more common stressors, even a routine colonoscopy or a bone fracture,” said cardiologist Tawakol. 

In addition, the research team found a relationship between stress-related brain activity and bone marrow activity. Several different types of blood cells needed to carry oxygen, launch immune responses and clot blood are made in the bone marrow. The MGH scientists concluded stress-related brain activity may negatively affect the production of those cells and, in turn, negatively impact cardiovascular health.

The bottom line, according to Tawakol, is that more studies are needed to find ways to lower stress-related brain activity to, hopefully, lower broken heart syndrome risk. Learning more about the impact of stress reduction — or drug interventions targeting stress-related brain activity — on heart health are also important, he added.

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