Heartbreak Can Break the Heart Itself

The Dangers of a Broken Heart

A 75-year-old patient of mine nearly died from what we initially believed was a heart attack. He had sudden crushing chest pain, abnormal EKG readings, and lab results that pointed strongly to a cardiac event. He was rushed to the catheterization lab, where we expected to find a blocked artery — the typical cause of a heart attack. But to everyone’s surprise, his coronary arteries were completely clear.

No blockages. No plaque. After several days in the cardiac care unit, the diagnosis became clear: broken heart syndrome.

This condition, now officially known as Takotsubo syndrome, was first described in Japan in 1990. Before it had a medical name, it was sometimes called “Voodoo Death” — a phrase used to describe sudden death following an intense emotional or terrifying experience. In some cultures, this was thought to be the result of a curse or hex, something mystical and unstoppable. But as cases began appearing in societies without these beliefs, the medical community realized something real and physiological was going on.

“These people who suffer from broken heart syndrome have chest pain, they have EKG changes. They can have arrhythmias and sudden death, and when you evaluate them, they look like a heart attack,” says Dr. Saul Schafer, a professor of cardiology at UC Davis Medical Center. “But in general, patients with Takotsubo have normal coronary arteries; that is, the arteries that supply blood to the heart. But (patients) have, in most cases, an increased sensitivity to catecholamines, things like adrenaline, that cause perhaps a vasoconstriction or narrowing of the arteries, or some other toxic effect on the cardiac cells.”

My patient had no prior history of heart disease. No smoking, no high blood pressure, no diabetes — none of the conventional risk factors. Once we ruled out a classic heart attack, Takotsubo became a strong possibility. It’s what we call a diagnosis of exclusion — a diagnosis made only after other possible causes are ruled out.

Often, Takotsubo follows a major emotional trauma: the death of a loved one, a divorce, a serious accident, or even a major fright. In this case, the patient eventually opened up. Just days before the onset of his symptoms, his wife had passed away from breast cancer. The grief was overwhelming.

This connection between profound emotional stress and the heart is a powerful reminder of how closely our physical health is tied to our emotional well-being.

While broken heart syndrome can be fatal, most patients survive — and recover.

“In general, most people improve, get better, get normal in one to four months with just supportive therapy,” says Dr Schafer.

No medication or surgery is needed. And most people will never experience a second episode.

My patient recovered with time, rest, and support. But even 35 years after Takotsubo syndrome was first named, we still don’t fully understand what causes it or why some people are more vulnerable than others, or how to prevent it. We also don’t understand why in Western countries most people affected are older women, while in Japan it affects mostly men.

What we do know is this: heartbreak can break the heart.

– Dr. Michael Wilkes with a Second Opinion