A broken heart can cause the heart to fail, for some. It’s been just a couple of decades since doctors began recognizing and diagnosing the heart condition called broken heart syndrome, or tako-tsubo cardiomyopathy. At first, it was not taken as seriously as other heart conditions, though it mimics a heart attack and can be serious — even fatal.
“It’s not as benign a condition as originally thought,” says Scott Sharkey, MD, a research cardiologist at the Minneapolis Heart Institute Foundation, and can lead to cardiac arrest. People with other medical conditions like obesity, hypertension, dyslipidemia, diabetes, and smoking are more likely to experience tako-tsubo cardiomyopathy, reports a review of clinical studies in the American Journal of Medicine, February 2015.
Symptoms of ‘Broken Heart Syndrome’
Tako-tsubo cardiomyopathy, also known as stress cardiomyopathy, was first recognized in Japan in 1991. It is more frequent among women; men make up only 10 percent of the cases. Symptoms occur abruptly and can include chest pain and sudden shortness of breath. Though a tragic event is often the trigger, symptoms can appear out of the blue in a small number of cases. The condition has even been reported after receiving unexpected good news.
“Stress cardiomyopathy implies everyone has a stressful event, but about 15 percent of patients do not,” Dr. Sharkey says.
People with the condition usually have abnormal results on an echocardiogram test. To definitively diagnose the condition, doctors administer an angiogram to rule out blocked arteries. They will also use a cardiac MRI or CT scan to examine the heart’s left ventricle, which contracts in a distinct way with tako-tsubo cardiomyopathy.
The heart’s abnormal contractions are treatable and usually go away after one to four weeks, Sharkey says. “Part of the diagnosis of the condition requires that that occur. So sometimes the diagnosis can only be done with certainty after time has passed.”
Heart Failure and Tako-tsubo Cardiomyopathy
Sharkey and his colleagues examined the medical histories of more than 200 tako-tsubo cardiomyopathy patients at the Minneapolis Heart Institute. They identified a small group of patients who also had severe heart failure and low blood pressure. These patients received aggressive treatments, like medications to increase blood pressure, and breathing machines. Of the 45 patients in that group, 9 died despite the medical interventions. All of the patients who died were female, and all had other risks such as advanced-stage cancer, Alzheimer’s disease, advanced age, or bleeding on the brain.
The overall in-hospital mortality rate of the 45 patients with both tako-tsubo cardiomyopathy and severe heart failure was 20 percent. This is higher than the typical in-hospital mortality rate of patients with both heart failure and myocardial infarction, or heart attack. The study’s results are important, Sharkey says, as a step toward determining the true seriousness of tako-tsubo cardiomyopathy.
“The true mortality rate is only becoming manifest as we have a broader experience with this,” Sharkey says.
The good news is that tako-tsubo cardiomyopathy patients, who do not have medical conditions other than heart failure, survive. This indicates that otherwise healthy people are likely to recover from broken heart syndrome even if they have heart failure along with it, Sharkey says. Clinical reports confirm that in-hospital deaths from tako-tsubo cardiomyopathy are rare.
Sharkey hopes that the medical community will devise more complete guidelines for treating people with broken heart syndrome, including which drugs are most effective. Aggressive treatment for heart failure and broken heart syndrome will be successful in the vast majority of cases, Sharkey adds. Patients’ families can take comfort in the fact that their loved ones will likely survive an experience with tako-tsubo cardiomyopathy.
“Even though they look very ill, if they do not have some other serious medical condition that is contributing to their state of health, then this is a very survivable event,” Sharkey says.