Banner by Katherine Greener

Don't Go Breaking My Heart

by Reyna Jones

Is it possible to die of a broken heart? In Shakespeare’s The Tragedy of Romeo and Juliet, Lady Montague, drowning in grief, sadly dies of a broken heart when her son Romeo is exiled after killing Juliet’s cousin Tybalt. Although the Bard lived hundreds of years ago, dying from heartbreak is not simply a circumstance of the past. We see and hear about the phenomenon all the time in contemporary movies and literature, and regrettably, even in real life. When Debbie Reynolds, renowned actress and singer died only one day after her equally famous daughter Carrie Fisher, known for her role as Princess Leia in the Star Wars films, many believed that Reynolds died of a broken heart. However, is there any science to back up the diagnosis of a broken heart? Or is this merely a metaphor for emotional pain? In actuality, an individual can suffer and even die from a broken heart. The medical condition is commonly called broken heart syndrome and also carries the names stress cardiomyopathy, LV apical ballooning syndrome or takotsubo cardiomyopathy.  

Why are there so many names for this condition? The term stress cardiomyopathy was used in 1980 when researchers were studying murder victims who experienced physical assault but did not sustain internal injury. They discovered that the victims demonstrated cardiac changes including cardiac muscle injury that they classified as human stress cardiomyopathy. The condition was later studied and documented as takotsubo cardiomyopathy in Japan in the 1990s. However, the condition was not well known in the western world. Therefore, Japanese scientists introduced case studies of what they initially called takotsubo cardiomyopathy, as LV apical ballooning syndrome (a name that was more indicative of what happens to the heart when an individual has the condition) at a conference in 2001, years after the illness was first identified. Four years later in 2005, stress cardiomyopathy became internationally recognized when an article published in the New England Journal described several individuals that were diagnosed with the condition after the death of a loved one. Coincidentally, or perhaps not, the article was published close to Valentine's Day, gaining media attention which prompted the fourth name: broken heart syndrome.

Although the specific cause of broken heart syndrome is unknown, it is typically found in postmenopausal women over 50 and is correlated with stressful situations such as the death of a spouse or a shocking diagnosis. Scientists believe that waves of stress hormones such as adrenaline can cause physical changes to the heart that are associated with the condition. Broken heart syndrome results in the weakening of the left ventricle of the heart, causing it to balloon out and resemble a Japanese octopus trapping vessel (hence the term “takotsubo” which means "octopus pot" in Japanese). Weakening and ineffective contractions of the heart may lead to direct cardiovascular consequences such as an irregular heartbeat, low blood pressure, and inadequate blood flow due to the heart’s inability to pump properly.

Interestingly, the symptom presentation of broken heart syndrome is similar to that of a heart attack, making diagnosis difficult. Patients often experience chest pain and shortness of breath. However, with further examination, there are key differences that enable doctors to make the correct diagnosis. First, testing will reveal blockages in the arteries for patients experiencing a heart attack, whereas blockages do not occur in patients with broken heart syndrome. Additional distinctions are present in an EKG (recording of the electrical activity of the heart) and echocardiogram (sonogram of the heart).

Although broken heart syndrome can be deadly, most patients with the condition can seek treatment and physically recover within a month of the experience. While there is not a standardized treatment plan, many patients are prescribed heart medication like ACE inhibitors and beta blockers which help to reduce the strain on the heart. However, emotional pain or severe stress can take longer to heal and manage. According to data from the International Takotsubo Registry, acute or chronic psychological and neurological issues are more prevalent in patients suffering from broken heart syndrome than heart attacks. Therefore, it is likely essential to take a holistic approach to treat patients with broken heart syndrome. In addition to medication and monitoring of the heart, treatment should also include steps to improving mental health. For example, it may be advantageous for patients to seek counseling to learn stress management and coping skills that can benefit them in the long-term.

The concept of dying of a broken heart has prevailed for centuries with a greater emphasis on the emotional component of the condition. However, it is imperative to recognize that although broken heart syndrome does have deep roots in emotional suffering and pain, there are physiological consequences that have been long unknown and overlooked. Broken heart syndrome is a complex and very real heart condition tangled in aspects of mental and physical health that scientists are still in the early stages of understanding.