Broken Heart Syndrome: When Hearts Break

The heart can actually become sick with grief. This may look like a heart attack, but it isn't. Experts have now agreed on therapy recommendations

Broken heart: Emotional stress can affect the pumping capacity of the heart. The symptoms are similar to a heart attack, but in comparison, broken heart syndrome is rare

© Mauritius / Masterfile

In the medieval legend, Isolde suffers a sudden cardiac death out of mourning for her beloved Tristan. In Goethe's novel "Wilhelm Meister's Apprenticeship", the girl Mignon dies of Herzeleid. The common parlance also knows the broken heart. But it has only been medically recognized since the beginning of the 1990s that our pumping organ can become ill from grief.

How the so-called broken heart syndrome comes about is far from being fully understood. But there are new insights into the causes. And last year, for the first time, an international team of experts published recommendations on diagnosis and treatment.

Paralyzed by stress

Of course, the heart muscle usually doesn't actually tear in two. But as a result of massive emotional stress - in some cases an overwhelmingly positive experience - the pumping performance can decrease acutely. In extreme cases, this leads to cardiogenic shock: the blood pressure drops and the body is no longer supplied with sufficient blood. A good five percent of patients die, as the data from a large registry show.

Professor Henning Baberg is medical director and chief physician for cardiology and nephrology at the Helios Clinic in Berlin-Buch

© W & B / Andreas Müller

Compared to other heart conditions, broken heart syndrome is rare. Experts estimate that around two percent of all patients who come to hospital with suspected heart attacks are affected. Women get sick far more often than men, especially after menopause. Why is a mystery.

Professor Henning Baberg, medical director and chief physician of cardiology and nephrology at the Helios-Klinikum Berlin-Buch, does not want to speak of a typical female heart disease: "The risk would be too great to overlook the clinical picture in a man."

Shortness of breath, tightness, pain

Anyway, broken heart syndrome is not easy to spot. The symptoms are very similar to those of a heart attack: shortness of breath, tightness in the chest, sometimes massive pain. Often the blood pressure drops, the heart races, the patient breaks out in a sweat, they suffer from nausea and vomiting.

The recordings of the EKG are also often similar to those of heart attack patients in whom a coronary artery is blocked. "I remember my time as a young intern well," says Baberg. "There were patients who had all the signs of a heart attack - but no abnormalities in the coronary arteries."

These substances have a direct effect on cardiac activity. If the level of stress hormones rises sharply, the heart muscle cells may be overwhelmed and stop working. The "broken" heart is therefore calmed down with medication. Doctors use various active ingredients for this.

Heart and head - one connection

But why do only a few emotionally stressed people suffer from broken heart syndrome? Scientists from the University Hospital Zurich recently published a possible answer. "We have observed that certain areas in the brain of Takotsubo patients communicate poorly with one another," says Dr. Jelena Templin-Ghadri.

The researchers focused on regions that are important for processing emotions and regions that control unconscious body functions - such as the heartbeat. "We have thus found a first indication of the way in which overwhelming feelings can actually have a direct effect on heart function," says Templin-Ghadri.

Heart in stress: signs, causes, diagnosis, therapy

© W & B / Jörg Neisel


© W & B / Jörg Neisel


Typical symptoms of broken heart syndrome are shortness of breath and chest pain - the same as those of a heart attack

© W & B / Jörg Neisel


Stressful events such as the death of a close relative or separation from a partner are the most common causes

© W & B / Jörg Neisel


An X-ray of the coronary arteries and the left ventricle as well as further examinations can help the doctor differentiate the syndrome from a heart attack

© W & B / Jörg Neisel


Medicines relieve and support the heart. They also lower the risk of further complications


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It was not until the 1990s that Japanese researchers realized that the heart muscle was partially paralyzed in some of these patients. This usually affects the left ventricle, which can inflate like a balloon. The scientists were reminded of a typical clay octopus trap called Takotsubo. This gave the disease its technical name: Takotsubo syndrome.

Medicines for broken hearts

However, doctors cannot rely on the bulge to make a diagnosis; it is not always visible. "We therefore proceed according to the principle of exclusion," said Baberg. "If a patient with the symptoms doesn't have a heart attack, we need to consider Takotsubo syndrome."

How it comes to paralysis of the heart muscle is not yet fully understood. A research group from Göttingen has established that there is a genetic predisposition for this. We also know today that the heart muscle cells of those affected are up to six times more sensitive to stress hormones, so-called catecholamines.

In broken heart syndrome, the shape of the left ventricle is reminiscent of a pitcher for catching squid (click on the magnifying glass)

© W & B / Dr. Ulrike Möhle arr. Jörg Neisel

The cardiologist is a member of an international team of experts that issued recommendations for the treatment of Takotsubo syndrome for the first time last year. "In it we emphasize the importance of examining which harrowing or joyful events may have affected the patient's heart," says Templin-Ghadri. It makes sense to accompany those affected with psychotherapy in order to avoid relapses.

Similar to a heart attack

A recurrence is by no means rare, emphasizes the expert. In addition, there could be complications such as blood clots in the heart chamber or cardiac arrhythmias. Therefore, the patients would have to be carefully monitored, possibly over a longer period of time. "For me this is the most important recommendation of the team of experts," confirms the Berlin cardiologist Baberg.

Takotsubo syndrome has been underestimated in the past. His urgent advice to those affected: "If you have symptoms such as chest pain and shortness of breath, be sure to dial 112!" Because a heart problem from grief is no less dangerous than a heart attack.