Nothing Breaks Like a Heart

Loss is a painful part of life that we must endure. Whether it’s the passing of a loved one, the end of a relationship, rejection, or betrayal, it’s common we feel “heartbroken” after permanent distance is put between us and people or things we were dedicated to. Or as Miley Cyrus wisely put it: “This world can hurt you/ It cuts you deep and leaves a scar /Things fall apart, but nothing breaks like a heart…”

An inaccurate depiction of a heart when it breaks

                                                                   
For most people, being heartbroken is just in our head; but in some rare cases, the extreme stress that results from loss can actually cause the heart to weaken and bulge. This reaction is most commonly referred to as broken heart syndrome, but can also be called stress-induced/takotsubo cardiomyopathy. (Fun fact: a takotsubo is a Japanese octopus trap that has a similar look to the shape of the heart when it “breaks.”)

Before we get into what actually happens to the heart by those affected with the syndrome, I’d like to give a warning to all of the ladies reading this blog post. According to the Harvard Health Publishing, about 90% of the cases of broken heart syndrome are found in women in the age range of 58-75. More importantly, about 5% of women who are told they had a heart attack actually have broken heart syndrome. Why does this misdiagnosis occur, you ask? Oh, because the signs and symptoms of a heart attack and broken heart syndrome are identical.

I think if I were reading this blog post out loud to a large group of people a hush would’ve fallen over the room. Or maybe someone would dramatically gasp and faint into the arms of a stranger. Either way, it may sound crazy that they are nearly indistinguishable but it makes sense that they are, as both heart attacks and broken heart syndrome are commonly linked with pain in the chest and difficulty breathing as a result of extreme stress.

Stress is the biggest cause of broken heart syndrome

Let’s quickly review some of these signs and symptoms, just in case. Both a heart attack and broken heart syndrome can be caused by a decrease in blood pressure, violence, asthma, unexpected events, arguments, loss, surprises, pain, illness, procedures, or even public speaking. All of these are linked by an increased level of stress.

Broken heart syndrome causes the left ventricle of the heart, which pumps oxygenated blood to the rest of the body, to get weaker due to stress hormones that create changes in blood vessels and/or muscle cells, which in turn inhibit effective contraction. The most common hormone is adrenaline, which can disrupt the normal beat of the heart, by "stunning" it. According to Mayo Clinic, drugs can increase the chance of broken heart syndrome as well, because they can increase the level of stress hormones in the bloodstream.

In order to properly diagnose broken heart syndrome instead of a heart attack, doctors must determine that the arteries were not blocked and that the left ventricle balloons. In a heart attack, a blood clot blocks the artery while in broken heart syndrome the blood flow just experiences a reduction. This ballooning is caused by the apex of the left ventricle bulging outwards while the other portions of the chamber continue to pump blood at normal levels. This process is the connection between the shape of the heart and the Japanese octopus trap pictured below.

Left: Ballooning of the left ventricle; Right: Takotsubo octopus trap

                                                 
The good thing about apical ballooning is that much like the balloons at your eighth birthday party, over time they deflate. Doctors usually prescribe regular heart failure medications and aspirin. In order to make a full recovery, the stress that caused the broken heart cannot continue to be part of the patient’s life. With the right treatment, people affected can be back to normal in about 2 months. In some rare cases, broken heart syndrome can be fatal, or it can lead to hypotension, irregular heart beat, or fluid in the lungs. That's why it is important to go to the doctor if you experience shortness of breath or pain in the chest after any of the symptoms stated before.