The pain from a catastrophic life event can be massive and sometimes not just limited to emotional distress.
Everyone knows of a long-married couple that died just weeks or months apart or has seen headlines about a parent who dies shortly after losing their beloved child. Many chalk it up to a broken heart.
But can one actually suffer physically from emotional pain?
The heart can physically change in response to emotional distress, according to Northeastern University medical experts.
“Broken heart syndrome” is when the heart temporarily enlarges and doesn’t pump properly, leading to symptoms that mimic a heart attack. It is also known as stress cardiomyopathy, apical ballooning syndrome, or Takotsubo cardiomyopathy. It was first described by Japanese doctor Hikaru Sato and was recognized as a clinical syndrome in the 1990s.
“It’s this physical geometric change in the shape of the heart in response to a stressful event, be that an infection, trauma, death of a family member, or huge financial problem,” said Glenna Regan, director of didactic education and assistant clinical professor of medical sciences at Northeastern University. “A whole slew of things can cause a sudden acute stress response in the human body that can ultimately lead to the heart physically changing shape.”
In patients with broken heart syndrome, part of the heart’s ventricle contracts improperly, so it looks like an octopus trap, said Andrew Mackie, associate clinical professor of medical sciences at Northeastern University. This is where the syndrome gets its name, as takotsubo means octopus trap in Japanese.
The patient will often present with heart attack syndromes in this case, Mackie said. This includes shortness of breath and chest pain.
“In Takotsubo cardiomyopathy, not only is there no coronary obstruction, but the only part of the ventricle that contracts normally is the ‘base’ (the part towards the head), while the middle and lower portions of our cut ‘football’ balloon out instead of contracting in,” Mackie explained. “So, the ventricle looks like the octopus trap, which is shaped like the animal’s head.”
The exact prevalence of broken heart syndrome is unclear, but Regan said it’s suspected that about 2% to 3% of patients with heart attack syndromes may actually have Takotsubo cardiomyopathy. Usually, lab tests or an ultrasound of the heart can be used to determine the difference.
Patients suffering Takotsubo cardiomyopathy will have lower cardiac enzymes than a heart attack patient and an ultrasound will show the changed heart shape. A cardiac catheterization lab, where clinicians snake a catheter into a patient’s blood vessels and shoot contrast dye into their arteries to check for a blockage.
Part of the reason Takotsubo syndrome is called broken heart syndrome is because it’s prompted by emotional distress in many cases, whether it be losing a loved one or surviving a natural disaster. It can also develop in response to infections or physical trauma, Regan said.
What exactly prompts it is unclear.“There are a number of theories,” Mackie said. “One is the release of catecholamines (such as adrenaline) during severe stress. These stimulate beta receptors in the heart, which help you respond to a sudden threat. One theory postulates that their distribution in the ventricle occurs more in the areas where the ballooning is seen.
“Signals from the brain can also lead to catecholamine release, which makes sense in the emotional precipitants. Downstream effects can include spasm of small vessels in the heart, which can have a different distribution than the larger vessels blocked in true heart attacks.”
This is more likely to occur in women over the age of 50, which suggests hormones can play a factor, Mackie said.
The changing of the heart shape can prompt a patient to go into heart failure, Regan said, which can lead to cold sweats, fatigue, shortness of breath and blood backing up into the lungs. But these symptoms can be managed with medication.
There’s not much one can do to prevent broken heart syndrome, but Regan said most patients recover from it when it does strike.
“The good news is that the majority of people will transiently recover within the span of weeks to months, and they’re at no greater risk for this happening again as far as we know,” she said. “We treat them like we would most other heart failure patients.”