Yes, a bad breakup actually can break your heart

If you’ve been through a sudden romantic breakup or the surprising loss of a loved one, you know what a broken heart feels like. But can these experiences actually—literally—break your heart?

Yes, they can, and they do.

The condition is called broken heart syndrome. Also known as stress cardiomyopathy, neurogenic stunned myocardium, takotsubo cardiomyopathy, and apical ballooning syndrome, it can occur at times of acute emotional stress, such as the sudden death of a loved one—hence the “broken heart” description.

The pathogenesis of heartbreak?

Broken heart syndrome is most prevalent in older, postmenopausal women, and usually resolves after a month.

Mimicking acute coronary syndrome, broken heart syndrome is accompanied by reversible left ventricular apical ballooning of no apparent cause with an absence of angiographically significant coronary artery stenosis. It can be easily misdiagnosed as a heart attack because patients typically present with classic myocardial chest pain and moderately increased cardiac enzymes (particularly troponins). It’s also characterized by electrocardiographic abnormalities, such as ST-segment elevation and/or T-wave inversion.

The syndrome was originally identified by Japanese scientists in 1991, who thought the unusual apical ballooning appearance on echocardiogram resembled a traditional Japanese “takotsubo”—a round fishing trap used for catching octopus. Researchers initially considered it a rare phenomenon, but more recent data indicate that the syndrome accounts for more than 2% of all patients presenting with suspected acute coronary syndrome with ST-segment elevation.

The pathogenesis of broken heart syndrome has yet to be determined, but the three proposed mechanisms include coronary vasospasm, microvascular spasm, and catecholamine-induced neurogenic stunning of the myocardium.

An unequivocal link

Regardless of the etiology, something occurring in the brain affects the heart.

“There is [an] unequivocal link between the state of mind and the development of takotsubo syndrome,” wrote Shams Younis-Hassan, MD, senior researcher, Unit for Heart and Lung disease, Karolinska Institute, Stockholm, Sweden.

“The frequent association of [broken heart syndrome] with sudden and intense emotional stress suggests that the mechanism of transient ventricular myocardial dysfunction might be sympathetically mediated,” wrote Dr. Younis-Hassan, adding that an emotional or a physical stressor is reported in more than two thirds of these patients.

A more poetic way to look at it: “Every heart has two parts, the part that pumps and the part that loves. If you’re going to spend your life fixing broken hearts, then learn about both,” wrote author Charles Martin. “You can’t just fix one with no concern for the other.”