Broken heart syndrome is real
How emotional pain can turn into a serious physical condition
Weeks after Gen Anthony arrived home from work to find her husband had moved out without warning, her girlfriends took her to dinner.
They were still being friendly with her ex, and Anthony was perplexed by what seemed like a lack of loyalty.
“You don’t understand,” she told them at the time. “This is literally killing me.”
It wasn’t just histrionics. Anthony was experiencing not just emotional but also physical pain, including symptoms she described as a “repeated punch” in the heart. The four-year marriage was less than perfect, but the end came without warning, she says. For the next month, when Anthony got home from work, she would hang up her coat and drag herself into bed with little energy for anything but deep breathing.
When her mother suddenly died in 2013, Anthony felt these familiar symptoms. She was so worried she would have a heart attack that she asked her doctor for a stress test. The pain this time was more like an intense ache, such as one would experience after a strenuous workout. Deep and meditative breathing again helped soothe her grief.
Not only had her physical pain returned, but her perspective changed: She felt more empathetic toward strangers, realizing that they too could be invisibly crippled by emotional turmoil. “With divorce being so rampant, I saw the world very differently,” says Anthony, a Toronto resident who works in management. “Everyone could be going through an internal trauma. There was bruising in my heart.”
What Anthony didn’t know at the time was that hearts can actually “break” from emotional stress.
What may have once been considered an exaggeration is now understood by the medical community as a serious and potentially life-changing condition. Takotsubo cardiomyopathy, also known as stressinduced cardiomyopathy or broken heart syndrome, was first diagnosed in 1990. The syndrome “has a dramatic clinical presentation, mimicking acute myocardial infarction,” or heart attack, according to a 2017 study led by scientists at the University of Aberdeen and published in the journal Circulation.
It can result in “persistent symptoms of heart failure because of physical, rather than emotional, disability,” that study states, even in patients with no history of heart disease.
The exact cause is not known, but it’s believed a sudden surge of stress hormones called catecholamines, more commonly known as adrenalin, can stun the heart by temporarily constricting the coronary artery or by impairing the function of the left ventricle, the heart’s main pumping chamber. The women who spoke to the Star about their symptoms all reported their heartbreak came as a shock.
“The symptoms in general are very similar to a heart attack,” says Dr. Diego Delgado, a cardiologist at the Peter Munk Cardiac Centre, who has treated patients who were rushed to the ER believing they were having a typical heart attack.
But in these cases, the chest pain and shortness of breath was typically preceded by a highly stressful situation, whether physical, emotional or psychological, such as a breakdown, divorce, a death in the family, a psychiatric event or major financial loss.
After diagnostic tests, an echocardiogram will show a ballooning of the heart’s left ventricle, a shape which led Japanese doctors to name the syndrome after the word for the bulbous shape of an octopus trap used by fishers in the region.
Broken heart syndrome is not caused by a blood clot or narrowing of the arteries, but like a traditional heart attack, the long-term consequences can be serious.
In the Scottish study, the 37 study participants with broken heart syndrome were shown to have greater exercise limitation due to severe fatigue and reduced oxygen uptake as compared to a control group, even a year or longer after the acute event had passed. Broken hearts also showed “subtle abnormalities” in ventricular function. And doctors say the condition may return after a second stressful event, similar to Anthony’s experience. The most common demographic for broken heart syndrome is post-menopausal women, but Dr. Harmony Reynolds, a cardiologist at New York University, believes the condition is underreported.
The university developed the national Broken Heart Syndrome Registry, which launched in January. So far 75 patients have self-reported their experience and ongoing quality of life and provided medical records for clinical research purposes.
“We’d like to know more about who is susceptible,” Reynolds says. She hopes to expand the registry to Canada later this year, and wants patients and physicians both to take broken heart syndrome seriously as a type of heart attack, one that should be diagnosed by a doctor in a hospital, not the heartbroken themselves.
For Veena Singh, two different heartbreaks in the past year — the unexpected death of an ex-partner and discovering the person she was dating had another girlfriend — manifested as physical: loss of appetite, inability to sleep, chest tightness, nausea and the amplification of regularly occurring back pain.
Singh, 24, a realtor and media production student, is a marathon runner who has an irregular heartbeat, so she is highly aware of her heart. She knew she was reacting to the stress, but the chest pangs felt like “a sharp stabbing pain. Literally like stabbing with a knife. Sharp and direct.”
“It was the first time I’d experienced physical symptoms of loss,” Singh says. Coping physically was more helpful than therapy, said Singh, who took hot baths and did yoga. “You force yourself to physically relax, so you mentally and emotionally relax as well.” She now feels back to normal. Of course, not all hearts will actually — even if temporarily — break.
While broken heart syndrome is rare, affecting an estimated 2 per cent of the population, psychological stresses such as depression, anxiety, social isolation and low socioeconomic status are also risk factors for heart disease. So are smoking and high blood pressure, says social psychologist Sherry Grace, a York University professor and senior scientist at the University Health Network’s cardiac rehab unit.
Depressed and anxious people are more likely to smoke, eat a poor diet, remain sedentary and show signs of inflammation and increased presence of catecholamines, all of which interact and are linked to heart disease, Grace says.
“If you have a breakup, there’s a lot of mental anguish and physically it hurts. You get butterflies in the stomach, you might feel your heart pounding. The physical manifestations are not always as severe as broken heart syndrome, but people need to take care of themselves and engage in positive actions to help them cope with it.”
Mindfulness and breathing, reaching out to a support network, and reframing the breakup narrative to a more positive story can all reduce the stress of a breakup — and help get over it faster.
“The longer you suffer in this way, the harder it is on your heart,” Grace says.
“The symptoms in general are very similar to a heart attack.” DR. DIEGO DELGADO CARDIOLOGIST AT THE PETER MUNK CARDIAC CENTRE