Broken heart syndrome

Broken heart syndrome is a suddenly occurring condition of the heart muscle – known medically as cardiomyopathy. It is characterized by a disruption in the functioning of the left ventricle (lower chamber) of the heart.

The syndrome is often triggered by emotional anguish and physical or psychological stress. This is why it is known as broken heart syndrome or stress-induced cardiomyopathy. In rare cases, it may be caused by other underlying conditions. In some cases, there is no obvious trigger.

The symptoms of broken heart syndrome are very similar to those of a heart attack. However, in contrast to a heart attack, the coronary vessels are not blocked and remain fully functional.

Broken heart syndrome most commonly affects women after the menopause.

It usually clears up completely after a few weeks. Serious complications are rare.

As broken heart syndrome has only been known about for a relatively short time and is also relatively rare, there are still many unanswered questions relating to this condition.

Sudden-onset chest pain, shortness of breath and fainting are the most common symptoms of broken heart syndrome. These symptoms are the same as those of a heart attack.

Some people develop complications, such as heart failure (cardiac insufficiency). Typical signs of heart failure are shortness of breath, tiredness, fatigue, and fluid retention in the body.

Researchers suspect that, in most cases, an emotionally distressing life event is responsible for triggering the condition. Such events include the loss of a loved one, a separation, or a traumatic event.

There are also some indications that certain therapies and, in rare cases, certain pre-existing conditions can also trigger broken heart syndrome. These include:

• treatment of cancer with chemotherapy
• blood poisoning (sepsis)
• respiratory diseases such as asthma or chronic obstructive pulmonary disease (COPD)
• mental health issues, such as anxiety disorders
• smoking and alcohol abuse
• drug consumption and withdrawal
• high cholesterol (hyperlipidemia)

More research is needed to determine exactly why these factors cause a malfunction of the left ventricle of the heart. It is suspected that advancing age and hormones have an important role to play.

For example, elevated levels of the stress hormones adrenalin and noradrenalin are often found in the blood of people with broken heart syndrome. These hormones can damage the heart muscle.

In addition, broken heart syndrome occurs most often in post-menopausal women. After the menopause, the female body no longer produces the sex hormone estrogen. It is assumed that this hormone alleviates the effects of stress hormones and, in this way, protects the cardiovascular system. If the body’s estrogen level declines, then its protection is also reduced.

In most people with broken heart syndrome, the heart returns to functioning as normal within a few weeks without any treatment.

However, complications sometimes occur and some of these can be life-threatening. They include:

• Cardiac arrhythmia
• Cardiogenic shock – in which the body is no longer able to provide the body with enough oxygen.
• Thromboembolism – in which a blood clot (thrombus) detaches from the wall of a blood vessel and enters the bloodstream. If the blood clot becomes stuck and blocks the blood flow, a stroke may occur as a result.

These complications are one of the reasons why between 1 and 5 percent of people with broken heart syndrome die in hospital. This is the case for men more often than women.

Broken heart syndrome is diagnosed using a process of elimination. This means that test results alone cannot confirm the syndrome.

One important test is a coronary angiography, which is a special type of X-ray. It indicates how well blood is flowing through the coronary vessels. This allows doctors to rule out a heart attack, which has very similar symptoms to broken heart syndrome.

The most important tests also include blood tests, an ultrasound of the heart (echocardiogram) and an electrocardiogram (ECG).

If a narrowing of the coronary vessels can be excluded as the cause of the symptoms, the doctor will talk to the patient to determine whether they have been experiencing any emotional or physical stress or stressful life events.

They will also ask about the patient’s lifestyle (including eating habits) and consumption of alcohol and cigarettes to obtain more useful information.

Most people recover from broken heart syndrome without treatment. No treatment is required for mild cases.

The main goal of therapy is to minimize the risk of complications or to treat any complications that arise as quickly as possible.

For this reason, the functioning of the heart must be monitored for at least 24 hours using an electrocardiogram (ECG). If a person with broken heart syndrome is at an increased risk of developing complications, they should be monitored for at least 72 hours.

If broken heart syndrome causes heart failure, this is treated with medication, such as beta-blockers and ACE inhibitors. These are intended to reduce strain on the heart muscle and improve its pumping power.

Intensive care is needed if serious complications arise. This is the case, for example, if a person develops cardiogenic shock. If this happens, the heart is no longer able to supply the body with enough oxygen. This function of the heart can be performed – at least temporarily – by a special machine in the intensive care unit.