How Common Is 'Broken Heart Syndrome'?
Study Suggests Men as Well as Women Have Condition That's Also Known as Stress Cardiomyopathy
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How Stress Cripples the Heart
Stress cardiomyopathy is thought to be at work in as many as 2% of people who are admitted to the hospital for a heart attack. Among women, that number is even higher, accounting for as many as 5% to 7% of those with suspected heart attacks, Wittstein says.
Though the mechanism isn't clear, researchers say it looks as though a surge in stress hormones causes blood vessels around the heart to constrict.
"When the very tiny blood vessels, the microvascular circulation, when that is affected, it can cause a temporary decrease in blood flow to the heart and cause a temporary stunning of the heart muscle," Wittstein says.
But unlike a heart attack, where heart cells actually die and there's scar tissue left, with stress cardiomyopathy, the heart muscle cells are temporarily stunned, but not irreversibly damaged.
"The heart muscle can look very weak at the time of [hospital] arrival, but it recovers completely," he says.
Most patients in the study presented with classic heart attack symptoms like chest pain and shortness of breath, but others were evaluated after they fainted or their heart suddenly stopped beating.
A few patients were admitted to the hospital after doctors suspected heart problems during other kinds of routine procedures.
All study participants had coronary angiograms, minimally invasive procedures that allow doctors to look for blocked arteries around the heart that may have caused a heart attack.
But those angiograms showed that 75% of patients in the study had healthy coronary arteries.
Others had blockages that were either too minimal or were in the wrong place to be causing their symptoms.
None had evidence of recently ruptured plaques, another hallmark of a heart attack.
Doctors could also see that the heart's main pumping chambers were weakened and distended, causing them to balloon when filled with blood.
All cases were then evaluated with cardiac magnetic resonance imaging (MRI) scans.
Those scans confirmed the heart chamber ballooning, and doctors could also see that in 81% of cases the heart muscle itself was also very swollen.
After the diagnoses were confirmed, patients were treated with drugs to manage blood pressure and heart failure.
Eight patients died during the study, but the vast majority made a full recovery. Their scans looked normal after six months.
"You can look very sick," Wittstein says. "The good news is that you are left with a normal heart muscle by the time all is said and done."
Even though people who have broken heart syndrome nearly always bounce back, doctors say it would be a mistake for someone to try to self-diagnose the condition, since stress can also cause true heart attacks.
"You've got to remember 98% of the time, when you have a heart-attack-like syndrome, it's going to be a real heart attack," Hanna says. "This is not rare, we see this a lot, but we see garden variety coronary artery disease and heart attacks way more than this."