Broken Heart Syndrome - when a heart attack isn't a heart attack

It's been sung about many times and is the proverbial heartbreak when love goes wrong - the broken heart.

Little known is that this phenomenon really exists and is described in medicine as broken heart syndrome. Other terms used are stress cardiomyopathy or Takotsubo cardiomyopathy. The latter name comes from the clay pots used by some Asian fishermen to catch octopus. In Takotsubo cardiomyopathy the left ventricle changes because the heart's apex contracts only weakly or hardly at all. The upper part narrows and there is a bulge toward the apex, giving it a shape similar to that clay pot.

Broken heart syndrome causes the same symptoms as a heart attack. The complaints are the same. You see ECG changes typical of a heart attack, but these cannot be clearly assigned to a single area of the heart. Blood tests also point to a heart attack. In about 2 percent of patients suspected of having a heart attack, doctors are surprised during the subsequent cardiac catheter examination because there is no blocked vessel, which would normally characterize a heart attack. An echocardiogram, however, shows a vase-shaped change of the left ventricle and an apex that barely moves.

But broken heart syndrome should not be taken lightly, because it can also lead to serious, sometimes life-threatening complications such as severe heart rhythm disturbances up to 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 like violence, natural disasters or fear for one's livelihood after job loss. But positive events such as a wedding, winning the lottery or similar things can also be triggers. In all these cases there is a massive release of stress hormones. Researchers suspect the origin of the disease here. The huge surge of stress hormones overstimulates the heart wall. Specifically at the beta receptors this massive attack by the usually heart-strengthening catecholamines can reverse their effect at least this was observed in studies on mice and rats. There may be a spasm of the heart muscle or the coronary vessels. This also explains the limited movement of the apex: there are particularly many beta receptors there. It is thought that this is a protective mechanism of the body against dangerous overstimulation of the heart by the high concentration of stress hormones. Primarily affected are women beyond menopause, since the protective effect of estrogen on the heart decreases with lower estrogen levels. But men can also suffer from a broken heart.

Therefore the drug treatment of broken heart syndrome differs fundamentally from that of a heart attack. While drugs that act via the adrenaline (adrenergic) receptor are used in a heart attack, this would have no effect or, in the worst case, exactly the opposite effect in broken heart syndrome a worsening of the condition, because the adrenaline receptor is the "damaged" part in this case. That is why drugs that do not act through adrenaline-like mechanisms are considered. In addition to medication, psychological support is important perhaps even more so. Coping strategies for stressful situations must be learned and the traumatic experience that led to the broken heart syndrome must be worked through.

In most cases the heart recovers completely from broken heart syndrome. After one to four weeks all changes in the myocardium have usually disappeared provided the patient has survived the acute phase without complications.

So Udo Lindenberg is wrong when he sings: "Ein Herz kann man nicht reparier'n."

A heart can be repaired, but it needs medical help sadly, a broken heart does not heal completely on its own.

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This article comes from BloodPressureDB – the leading app since 2011 that helps hundreds of thousands monitor their blood pressure every day. Our content is based on carefully researched, evidence-based data and is continuously updated (as of 04/2024).

Author Sabine Croci is a qualified medical assistant with many years of experience in internal medicine and cardiology practices as well as in outpatient care, and has led BloodPressureDB's specialist editorial team since 2015. Thanks to her extensive additional qualifications as a paramedic, first responder and in various therapy and emergency areas, she provides solid, practical and reliably reviewed information.

Broken Heart Syndrome - when a heart attack isn't a heart attack

What happens in broken heart syndrome?

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