After a traumatic event like a divorce or the death of a loved one, some people may experience chest pain and shortness of breath — the result of a condition known colloquially as “broken heart syndrome.”
The syndrome, which doctors formally call takotsubo cardiomyopathy, is thought to be triggered by physical or emotional stress, which releases bursts of stress hormones like adrenaline that prevent people’s hearts from contracting properly. Most patients recover quickly, but a small minority suffer heart failure.
Although broken heart syndrome is most common in women, men die from it at more than twice the rate, according to a study published Wednesday in the Journal of the American Heart Association.
The study analyzed data from nearly 200,000 adults in the U.S. who were hospitalized with broken heart syndrome from 2016 to 2020. Around 11% of men in that group died, compared with roughly 5% of women. The data reinforce previous studies that showed higher mortality rates in men.
“It seems to be a consistent finding that men don’t get takotsubo syndrome as much, but when they do, they do worse,” said Dr. Harmony Reynolds, director of the Sarah Ross Soter Center for Women’s Cardiovascular Research at NYU Langone Health, who wasn’t involved in the study.
The differences between men and women may have something to do with what’s triggering their conditions, cardiologists said. In men, broken heart syndrome is usually brought on by a physical stressor, such as a surgery or stroke. In women, the impetus is typically emotional, like losing a job or loved one.
“The people with emotional stressors actually do quite well,” said Dr. Ilan Wittstein, a cardiologist at Johns Hopkins Medicine, who wasn’t part of the new research.
“Men may be more at risk for dying and having bad outcomes because they’re less susceptible to begin with,” he said. “So it takes a more dangerous trigger to precipitate the syndrome.”
The study’s lead author, Dr. Mohammad Movahed, said men may also have a harder time recovering from broken heart syndrome since they tend to have less social support to help them manage stress.
“If you have this stressful trigger, and the stress is not gone, that’s probably going to continue to harm the heart, or at least reduce the chance of recovery,” said Movahed, a cardiologist at the University of Arizona’s Sarver Heart Center.
But scientists still have lingering questions about what’s driving the syndrome, and why people die from it in rare cases.
“People are still looking for the holy grail of what causes this condition,” Wittstein said.
Is stress the only trigger?
To confirm that a person has broken heart syndrome, doctors look for a few tell-tale signs. In a typical patient, part of their heart muscle is enlarged like a balloon, but they do not have a blocked artery, which is usually associated with heart attacks. Most patients can also point to a stressful event that predated the episode.
“The stresses that we endure in our daily lives, both physical and emotional, can in fact take tolls on us,” said Dr. Matthew Tomey, a cardiologist at Mount Sinai Fuster Heart Hospital in New York City. “You can feel the heartache in those moments, and there may literally be some heartache of sorts that’s accompanying that.”
But Wittstein said stress alone may not be enough to trigger broken heart syndrome.
“Some people just get a little frustrated at work, or somebody was out jogging a little too vigorously, or somebody just got stuck at a red light and was annoyed,” he said.
Reynolds said one of her patients has had the syndrome four times — each event precipitated by minor stomach bugs that caused her to vomit.
“She just really hates vomiting and will throw up and get” takotsubo cardiomyopathy, she said.
Wittstein now believes some patients may have an underlying susceptibility to broken heart syndrome. His research suggests that stress hormones can constrict tiny blood vessels surrounding the heart, which decrease blood flow. That would make certain people, such as those with high blood pressure or high cholesterol, more susceptible, he said.
Research has also shown that post-menopausal women are more prone to broken heart syndrome. Wittstein said that’s probably due, in part, to a decline in estrogen, which helps dilate the tiny blood vessels around the heart.
But Reynolds said there’s not enough research to know that for sure.
“It’s at some level obvious that sex hormones are implicated but trying to draw that link and really connect the dots, we have not gotten there yet,” she said.
Hard to treat, hard to prevent
Cardiologists said the mysteries surrounding broken heart syndrome can make it hard to prevent or treat.
Doctors occasionally prescribe medications used for other heart issues, such as beta blockers, or find ways to help people reduce stress, such as meditating and talking to a mental health professional.
“We have not found anything so far — any medication, any specific treatment — that can reduce complications or reduce mortality,” Movahed said.
His new study found that deaths from broken heart syndrome were relatively stable from 2016 to 2020 — a sign that the current treatment landscape isn’t sufficient, he said.
But Wittstein said the study relied on diagnostic codes given to hospitalized patients, which can sometimes miss the full picture of what contributed to a person’s death, especially if that person had a stroke or other neurological issue.
“I’m quite sure that some of these people recovered from the broken heart syndrome and then died of complications of something else,” he said.
Cardiologists said their best advice is to encourage patients to go to the hospital if they have chest pain or shortness of breath, and not to dismiss their symptoms as stress.
“You can’t tell the difference between this and traditional heart attacks until you get to the hospital and have a series of tests,” Reynolds said. “So it is not appropriate to stay home when you have chest pain.”
