What is broken heart syndrome (Takotsubo cardiomyopathy)?

You may have heard someone say they were “heartbroken” after a major loss or stressful event. While that expression is usually not meant literally, there is a real medical condition known as broken heart syndrome.

Broken heart syndrome, also known as Takotsubo cardiomyopathy or stress-induced cardiomyopathy, is a sudden weakness in your heart muscle often caused by a surge in stress hormones. It is not life-threatening, and most people fully recover within two months. 

We spoke with cardiologist Leslie Ynalvez, M.D., to learn more about broken heart syndrome, including its causes, symptoms and how it can affect cancer treatment.

What causes broken heart syndrome?

The exact cause of broken heart syndrome isn’t fully understood. But experts believe a sudden surge in stress hormones triggers it in most people.

“Think of it as a sudden rise in adrenaline that stuns the heart muscle and can temporarily weaken its ability to pump effectively,” says Ynalvez.

Anything that causes stress – psychologically or emotionally – can trigger broken heart syndrome. Common stressors include:

• Severe infection
• Major blood loss
• Serious allergic reactions
• Medical state of shock: This is a life-threatening condition in which the circulatory system fails to deliver enough blood and oxygen to your body’s organs and tissues.
• Serious illness
• New cancer diagnosis
• Surgery or other medical procedures
• Severe pain
• Car accident
• Fierce argument
• Death of a loved one
• Loss of a home, pet or relationship
• Financial issues

Not everyone who experiences these things will develop broken heart syndrome. But they can increase the risk.

Who develops broken heart syndrome?

Anybody can develop broken heart syndrome. But the following may put you at higher risk for developing it:

• Being female: About 90% or more cases of broken heart syndrome occur in women.
• A history of mental health conditions, such as anxiety or depression
• A history of neurological illnesses, such as stroke, seizures/epilepsy or head injuries.

“The role that neurological illnesses play in your risk for broken heart syndrome highlights the deep communication axis between the brain and the heart, or the central nervous system’s influence on stress hormone regulation,” says Ynalvez.

What are the symptoms of broken heart syndrome?

The most common symptoms of broken heart syndrome are:

• Severe chest pressure or heaviness
• Chest pain
• Shortness of breath

These symptoms often mimic the symptoms of a heart attack, so it’s important to seek medical care right away.

Some people also develop swelling in both legs. This happens because a weakened heart can’t pump blood as efficiently. This allows fluid to build up in your body.

“Think of your cardiovascular system as a pump and pipe network,” says Ynalvez. When the pump (your heart) isn’t working properly, fluid can back up in the pipe (lungs and blood vessels in the legs). This leads to shortness of breath and swelling.

How is broken heart syndrome diagnosed?

“Any weakness in your heart muscle should be taken seriously,” says Ynalvez. “So, the first thing we want to do is see if it’s caused by a heart attack, blockages in the heart’s arteries or inflammation in the heart muscle.” 

Broken heart syndrome is a diagnosis of exclusion. “This means we will run tests to rule out common heart conditions before diagnosing broken heart syndrome,” says Ynalvez.

One of the first tests doctors will perform is often an angiogram. This is a procedure that uses X-rays to look at arteries that supply blood to your heart. This can help your doctor see if there are blockages in your arteries. If there are no blockages, doctors can typically rule out a heart attack.  

“While the angiogram is critical for looking at the arteries, we typically follow it up immediately with a left ventriculogram during the same procedure or an echocardiogram to look at the heart itself,” says Ynalvez. “This is done specifically to spot the characteristic ballooning, or weakening of the heart’s main chamber.”

How does broken heart syndrome affect your heart?

Broken heart syndrome stuns the heart muscle. Most cases don’t involve the entire heart. It usually affects the lower, pointed tip of the heart, known as the apex. This is called apical ballooning syndrome.

Apical ballooning syndrome occurs when the bottom portion of the heart is stunned and stops contracting normally. The area bulges outward (like a balloon) while the rest of the heart continues to pump. 

How is broken heart syndrome treated?

Treatment typically includes standard medications for heart failure, such as:

• Beta blockers
• ACE inhibitors
• or Angiotensin II receptor blockers (ARBs)

“We also encourage people to avoid stress, which can be more easily said than done,” says Ynalvez. “But if we know the stressor that is triggering the condition – caring for a sick loved one, for instance – then we can provide guidance or resources on how to manage that stress.”

How long does it take to recover from broken heart syndrome?

Fortunately, broken heart syndrome is usually a short-term and reversible condition. In most cases, medication can help a person’s heart function recover in one to two months.

“Unlike chronic heart failure, where patients often need to stay on medication indefinitely, those who recover fully from broken heart syndrome are often weaned off these drugs by their cardiologist once the heart muscle function has normalized,” says Ynalvez.

What should cancer patients know about broken heart syndrome?

Some cancer treatments can also weaken your heart muscle. This condition is known as cancer treatment-related cardiac dysfunction.

Examples include:

• Anthracyclines, a type of chemotherapy drug
• Trastuzumab, a targeted therapy used to treat HER2 positive breast cancer
• Radiation therapy to the chest

At UT MD Anderson, our cardiologists and oncologists work closely together to treat cancer patients while protecting their heart health. If you have stress-induced cardiomyopathy, we grade it on a scale of either mild, moderate or severe based on ejection fraction (the heart’s pumping function).

“If the cardiomyopathy is severe, we may talk to your oncologist about holding off on any treatments that may further weaken your heart,” says Ynalvez. “After a month, we’ll do a repeat echocardiogram to evaluate recovery. Most patients can safely continue with their cancer treatment if their heart function improves.”

In cases where the cancer is aggressive and requires more immediate treatment, we can do the echocardiogram sooner and adjust your treatment plan as needed, she adds.  

In some cases, we also help identify other treatments that are less likely to affect your heart when cancer is no longer responding to current treatments.

“The most important thing is ensuring that we carefully manage the cancer and your heart health,” says Ynalvez. “So close communication between specialists is key.”

Request an appointment at UT MD Anderson online or call 1-877-632-6789.