Don't Break My Heart

Its symptoms mimic a heart attack, but the causes of broken heart syndrome are widely unknown.

Forever, broken hearts have been immortalized in lyrics, poems and theater. Now, researchers are learning just how real that pain can be. For some people, strong emotion or physical stress can trigger a heart condition with symptoms very similar to those of a heart attack -- chest pain and shortness of breath.

The condition goes by several medical terms including stress-induced cardiomyopathy and left ventricular apical ballooning syndrome. But the nickname that sticks is broken heart syndrome. Most patients experience symptoms soon after a major stress, such as a death in the family or a surgery. When it occurs, the tip of the left ventricle, the heart's main pumping chamber, balloons out and weakens. The majority of patients are women age 60 and older. Researchers in Japan first identified the syndrome about 14 years ago. In 2004 and 2005, papers published in two U.S. medical journals garnered attention for the syndrome in this country.

"We've known that stress can increase the risk of heart attack. Now were seeing it can affect the heart itself," says Charanjit Rihal, M.D., a Mayo Clinic cardiologist and one of the authors of a review of broken heart syndrome published in the Annals of Internal Medicine.

While the symptoms are similar to those of a heart attack, broken heart syndrome is not likely to cause permanent heart damage. In a heart attack, the blood flow to the heart is blocked, which can quickly cause heart damage or death.

Patients with broken heart syndrome usually have no arterial blockages. But it's still a serious situation warranting urgent medical attention. Doctors treat the condition similarly to a heart attack and are prepared to deal with low blood pressure, heart failure, shock or heart rhythm abnormalities, should they occur. In a few days, most patients are nearly back to normal.

For now, those broken hearts haven't shared many secrets. Researchers don't know what exactly triggers the episodes in some people or why post-menopausal women are most often affected.

While relatively few cases have been documented in medical literature, Dr. Rihal suspects that the condition is not rare. "We think these cases have always been there, but probably mistaken for heart attack or other heart ailments," he says.