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Stress Cardiomyopathy

What You Should Know

  • Stress cardiomyopathy, also referred to as the “broken heart syndrome,” or “takotsubo,” is a condition in which intense emotional or physical stress can cause rapid and severe heart muscle weakness (cardiomyopathy).
  • Stress cardiomyopathy can exhibit symptoms similar to a heart attack.
  • Symptoms can appear quite suddenly and unexpectedly.
  • Occurs most frequently in women with an average age of 60 years old.
  • While the heart can be very weak initially, there is typically complete recovery within days to weeks with no residual heart muscle damage.

About Stress Cardiomyopathy

First, it is important to understand what “stress” is. “Stress” refers to the body’s response to things it perceives as abnormal. These abnormalities can be physical such as high body temperature, dehydration, or low blood sugar, or can be emotional, such as receiving news that a loved one has passed away. When these abnormalities occur, the body produces various hormones and proteins such as adrenaline and noradrenaline which are meant to help cope with the stress. For example, if a person is suddenly threatened and fears physical harm, the body produces large amounts of adrenaline to help that person either defend himself/herself or run faster to escape the danger. Adrenaline is also produced from physical stressors to the body such as stroke, seizure, difficulty breathing (such as a flare of asthma or emphysema), or significant bleeding. With stress cardiomyopathy, the heart muscle is overwhelmed by a massive amount of adrenaline that is suddenly produced in response to stress.

The precise way in which adrenaline affects the heart is unknown. It may cause narrowing of the arteries that supply the heart with blood, causing a temporary decrease in blood flow to the heart. Alternatively, the adrenaline may bind to the heart cells directly causing large amounts of calcium to enter the cells which renders them temporarily dysfunctional. The heart becomes misshapen, and a balloon effect can be seen on ultrasound or with a heart catheterization.

Whichever the mechanism, it appears that the effects of adrenaline on the heart in this syndrome are temporary and completely reversible. One of the main features of this syndrome is that the heart is only weakened for a brief period of time and there tends to be no permanent or long-term damage.