Broken heart syndrome: VCU researchers publish review on stress cardiomyopathy

Naomi Ghahrai

Contributing Writer

A team of VCU researchers recently highlighted a series of risk factors, evidence-based treatment and diagnosis related to broken heart syndrome in a clinical review published in the Journal of the American College of Cardiology.

Discovered in 1990 by Dr. Hikaru Sato of Hiroshima City Hospital and once considered rare, broken heart syndrome — also known as stress cardiomyopathy or takotsubo cardiomyopathy — is a condition of severe heart muscle weakness associated with intense emotional or physical stress, resembling a heart attack. One in every 20 cases of possible heart attacks are stress cardiomyopathies.

“This condition usually lasts from a few days to a few weeks and can cause people to die,” said Dr. Antonio Abbate, co-author of “Stress Cardiomyopathy Diagnosis and Treatment” and VCU School of Medicine cardiology professor. “There may be some long-lasting consequences like tiredness and shortness of breath which are still poorly understood.”

The clinical review — completed by Abbate and several other VCU psychiatry and cardiology professionals — links the functions of the brain and heart to define the mechanism of stress cardiomyopathy. In certain phases of the disease, there is a blood flow increase to areas of the brain. However, the exact mechanism behind this disease is still unknown.  

The review also highlighted certain risk factors and triggers of the disease while discussing possible challenges and unresolved questions surrounding the condition.

The most common physical stressors associated with broken heart syndrome are trauma, surgery and drug intoxication or withdrawal. The most common emotional stressors — although not easily identifiable — are the loss of a loved one, great financial loss, natural disasters and assault. Some risk factors include cannabis use disorder, asthma attacks and diabetes. Moreover, stress cardiomyopathy occurs more frequently in postmenopausal women.

The prevalence of this disease is increasing with 15 to 30 cases per 100,000 every year. However, the condition is underdiagnosed as its mechanism is not completely understood.

The review discussed the probabilities of broken heart syndrome complications and recurrences. Although stress cardiomyopathy is reversible within a few weeks, one in every 20 patients with stress cardiomyopathy experiences a complication such as severe heart failure, arrhythmia or stroke. Recurrences of stress cardiomyopathy are also common with a two to four percent annual risk of recurrence. The in-hospital mortality of this disease is approximately five percent.

“The rates of death in the hospital between stress cardiomyopathy [which mimics a heart attack] and more ‘traditional’ heart attacks are similar,” said Dr. Deepak Bhatt, cardiologist at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School. “Compared with people who had experienced a ‘typical’ heart attack, patients with stress cardiomyopathy are almost twice as likely to have a neurological or psychiatric disorder.”

The optimal treatment for broken heart syndrome is still unknown. Currently, the management for stress cardiomyopathy patients is “supportive care to sustain life and to minimize complications until full recovery,” according to the review. Therefore, additional trials are necessary to determine proper treatment.

“I hope the publication of this research can increase awareness and educate providers on management strategies for complications unique to this condition,” Abbate said. “Currently, we at VCU are conducting further research on how the brain and heart interact in this complex syndrome. Stay tuned.”