What Is “Broken Heart Syndrome,” And Why Are Middle-Aged Women So At-Risk?

We all know that heartbreak is painful. 

If you’ve experienced it, and odds are pretty good you have, you know the toll it takes on your emotional well-being. 

It’s painful — and sometimes, it hurts more than your feelings. 

It can physically hurt, and it’s not in your head.

Intense emotional stress could actually harm your heart muscle, and it’s called Broken Heart Syndrome (BHS). 

It’s very real, and it’s on the rise among middle-aged women.

What Is Broken Heart Syndrome?

According to Oxford Languages, Broken Heart Syndrome (noun) is “a condition characterized by sudden dysfunction of part of the left ventricle of the heart, accompanied by symptoms resembling those of a heart attack but occurring in the absence of significant coronary artery disease. Typically attributed to stressful events, the condition is usually transient.”

Although the name suggests an emotional reaction rather than an actual medical problem, it is a very real condition. 

Broken Heart Syndrome is known medically as takotsubo cardiomyopathy or stress-induced cardiomyopathy. As the name suggests, it’s triggered by extremely stressful situations, like the loss of a loved one or a similar traumatic event.

Broken Heart Syndrome Symptoms

Broken Heart Syndrome’s symptoms may feel like a heart attack — sufferers complain of chest pain and shortness of breath — but it’s caused by going through an emotionally stressful event instead of the usual causes of heart disease, such as clogged arteries.

The Mayo Clinic says signs and symptoms can mimic a heart attack and may include:

• Chest pain

• Shortness of breath

Chest pain may be a sign of a heart attack, so do not ignore it — see your healthcare provider or call 911.

Study: Condition On The Rise

New research from Cedars-Sinai suggests that broken heart syndrome, while still not common, is not as rare as was once thought. 

The cases are growing, especially among middle-aged and older women.

“This ‘middle’ group — women ages 50 to 74 — had the greatest rate of increase over the years studied, 2006-2017,” says Susan Cheng, MD, lead author of the study, published in the Journal of the American Heart Association. 

Dr. Cheng is the director of the Institute for Research on Healthy Aging at the Smidt Heart Institute at Cedars-Sinai Medical Center.

Cheng and her team used national hospital inpatient data collected from over 135,000 men and women diagnosed with the condition during the 12 years of the study. 

More than 88% of all cases were women, especially those age 50 or older. When the researchers looked more closely, they found the diagnosis has been increasing at least 6 to 10 times more rapidly for women in their 50’s-70’s than in any other group.

For every case of the condition in younger women, or in men of all age groups, the researchers found an additional 10 cases for middle-aged women and six additional cases for older women. 

For example, while the syndrome occurred in 15 younger women per million per year, it occurred in 128 middle-aged women per year.

The age groups found most at risk were startling, says Cheng, who assumed the risk would be highest in the oldest age group — women over 75.

While doctors are more aware of the condition now, “It’s not just the increased recognition,” she says. “There is something going on” driving the continual increase. It probably has something to do with environmental changes, she says.

Hormones and hormonal differences between men and women aren’t the whole story either, she says. 

Her team plans to study it further, in hopes of finding who may be more at risk to get BHS by talking to those who have had it and gathering more data. 

“There probably is some underlying genetic predisposition…The neural hormones that drive the flight-or-fight response (such as adrenaline) are definitely elevated,” she says. “The brain and the heart are talking to each other.”

Experts say these surging stress hormones essentially “stun” the heart, affecting how it functions. 

The question is, what makes women particularly more inclined to be unnecessarily triggered when exposed to stress? That is unclear, Cheng says.

While the condition is a frightening experience, ”The overall prognosis is much better than having a garden-variety heart attack,” she says.

But researchers are still figuring out long-term outcomes, and she cannot tell patients if they are likely to have another episode.

Research Findings Reflected In Practice

Other cardiologists say they are not surprised by the new findings.

“I think it’s very consistent with what I am seeing clinically,” says Tracy Stevens, MD, a cardiologist at Saint Luke’s Mid America Heart Institute in Kansas City, MO. In the last 5 years, she has diagnosed at least 100 cases, she says. The increase is partly but not entirely due to increased awareness by doctors of the condition, she agrees.

“If a postmenopausal woman comes to the hospital with chest pain, the condition is more likely now than in the past to be suspected,” says Stevens, who’s also medical director of the Muriel I. Kauffman Women’s Heart Center at Saint Luke’s. 

“The octopus pot-like image is hard to miss — what we see at the base of the left ventricle is, it is squeezing like crazy, it is ballooning.”

“We probably see at least five to 10 a month,” says Kevin Bybee, MD, an associate professor of medicine at the University of Missouri-Kansas City School of Medicine.

The increase in cases reported by Los Angeles researchers may not even capture the true picture of how many people have gotten this condition, he says.

He thinks some women whose deaths are blamed on sudden cardiac death might actually have had undiagnosed BHS.

“I have always wondered how many don’t make it to the hospital.”

And the pandemic could be playing a role in driving up cases. “In the last 2 years, we have been noticing increasing numbers of cases, probably due to the pandemic,” he says.

Broken Heart Syndrome Origins

In 1990, Japanese researchers named the disorder with a variation of the term “tako-tsubo”, which is a clay pot used by Japanese fishermen to trap octopi. 

The condition causes severe swelling of the left ventricle (one of two lower chambers in the heart), and the swollen ventricle looks similar to the clay pot. 

Signs and symptoms are nearly identical to those of a heart attack and may include sudden chest pain, shortness of breath, nausea, and an irregular heartbeat.

Strangely, most women with broken heart syndrome don’t have a history of heart disease. 

Although broken heart syndrome usually is not fatal, it causes heart failure in about 20% of cases. 

Fortunately, most affected people recover quickly, with no permanent damage to their heart muscle.

Broken Heart Syndrome Triggers

As for what triggers broken heart syndrome, cardiologists say that chronic stress over time can create serious health problems. 

Emotional stressors that may induce cardiomyopathy include:

• The sudden loss of a loved one

• Being fired from a job

• An automobile accident

• A sudden serious illness

• Domestic violence

• Experiencing immediate danger, loss, or injury from a natural disaster, such as a tornado or hurricane

Broken Heart Syndrome Treatments And Recovery

The condition is rarely fatal, say experts from Harvard and Mayo Clinic, but some can have complications such as heart failure.

“There are no standard guidelines for treatment,” Abhijeet Dhoble, MD, a cardiologist and associate professor of medicine at UT Health Science Center and Memorial Hermann-Texas Medical Center, says. “We give medications to keep blood pressures in the optimal range.” 

Doctors may also prescribe lipid-lowering medicines and blood thinner medications. 

“Most patients recover within 3 to 7 days,” Dr. Stevens says. “Usually within a month, their (heart) function returns to normal,” Stevens says.

Reducing Your Risk

If you suspect you are suffering from Broken Heart Syndrome, go see a doctor or provider who knows about the condition.

As cases rise, most cardiologists are very likely to suspect the condition, Bybee says, as are doctors working in a large-volume emergency department.

Stevens of St. Luke’s is straightforward and tells her patients what is known and what is not about the condition — she recommends her patients go to cardiac rehab.

“It gives them that confidence to know what they can do,” she says.

She also gives lifestyle advice, telling patients to purchase a home blood pressure cuff and use it, as well as eating healthy, exercising, and not lifting anything so heavy “that grunting is necessary.”

“Focus on protecting heart health,” Cheng tells patients. She urges them to find a stress-reduction plan that works for them. 

Most importantly, she tells patients to understand that Broken Heart Syndrome is not their fault.

For more information on BHS, click here.

Had you heard of Broken Heart Syndrome or its symptoms before? Let’s talk about it in the comments below.

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