Broken-Heart-Syndrome - when the heart attack is not a heart attack

It has been sung about many times and is proverbial in cases of heartbreak - the broken heart.

What is little known is that this phenomenon really exists and is also described in medicine as Broken-Heart-Syndrome. Other terms used for this are stress cardiomyopathy or Tako-Tsubo cardiomyopathy. The latter designation comes from the clay pots used by Asian fishermen to catch octopuses. In Tako-Tsubo cardiomyopathy, the left ventricle changes shape, as the heart beats only minimally or hardly at all at the apex. It narrows in the upper area and shows a bulge towards the apex, giving it an appearance similar to the described clay pot.

In Broken-Heart-Syndrome, identical symptoms occur as in a heart attack. The complaints are the same. The typical EKG changes of a heart attack appear. However, these cannot be clearly assigned to a specific area of the heart. The laboratory tests also indicate a heart attack. In about 2 percent of patients with the suspected diagnosis of heart attack, the examining doctors experience a surprise during the subsequent cardiac catheter examination, as no blocked vessel characteristic of a heart attack can be found. In the ultrasound examination of the heart, however, a vase-shaped altered left ventricle and a hardly moving heart apex can be seen.

However, Broken-Heart-Syndrome should not be taken lightly, as it can also lead to serious, sometimes life-threatening consequences such as severe arrhythmias or even cardiogenic shock.

What happens in Broken-Heart-Syndrome?

In most cases, Broken-Heart-Syndrome is preceded by an emotionally stressful event. The death of a loved one, the news of a serious illness, heartbreak, traumatic events such as violence, natural disasters, or existential fears after losing a job. But positive events such as a wedding, a lottery win, or similar can also be triggers. In all these cases, there is a massive release of stress hormones. Researchers suspect this to be the origin of the disease. The massive influx of stress hormones essentially overstimulates the heart wall. Specifically at the beta receptors, this massive attack of the heart-strengthening catecholamines causes a reversal of effect - at least this has been observed in research on mice and rats. It may lead to a spasm of the heart muscle or the coronary vessels. This also explains the movement restriction of the heart apex: there are particularly many beta receptors located there. It is suspected that this is a protective mechanism of the body against dangerous overstimulation of the heart due to the high concentration of stress hormones. Primarily, women beyond menopause are affected, as the protective effect of estrogen on the heart decreases with the declining estrogen levels. However, men can also suffer from a broken heart.

Therefore, the pharmacological treatment of Broken-Heart-Syndrome fundamentally differs from that of a heart attack. While medications that act on the adrenaline receptor are used for a heart attack, this would have no effect or, at worst, the exact opposite effect in the case of Broken-Heart-Syndrome - a deterioration of the condition, as the adrenaline receptor represents the "damaged" part in this case. Therefore, substances that do not act through adrenaline-like mechanisms are considered in this case. In addition to pharmacological therapy, psychological support is also important - perhaps even more important. Coping strategies for stressful situations must be learned, and the traumatic experience of Broken-Heart-Syndrome must be processed.

In the case of Broken-Heart-Syndrome, the heart usually heals completely in most cases. After one to four weeks, all changes in the myocardium have disappeared - provided the patient has survived the acute phase unscathed.

Here, Udo Lindenberg is mistaken when he sings: "A heart cannot be repaired."

A heart can indeed be repaired, but it requires medical help, as a broken heart unfortunately does not heal completely on its own.

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By Sabine Croci. This article is medically reviewed. Last updated (04/2024).
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Broken-Heart-Syndrome - when the heart attack is not a heart attack

What happens in Broken-Heart-Syndrome?

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