Breaking one’s heart may sound like a figurative expression—a favorite phrase in many love songs.

Common drawings show a split image of the heart with a jagged line on its inner edges. Scientific data published in the last two decades, however, tells us that such visual representation may not be far from reality.

Years ago, our medical resident, on duty at the emergency room of Manila Doctor’s Hospital, woke me up past midnight with an urgent referral. The fiftysomething sister of one of my patients was rushed to the ER by her husband, suffering from severe chest pains and shortness of breath.

She had no history of heart problem and was well until that day. A fast heartbeat was noted in the physical examination. The symptoms were felt after a quarrel with her husband.

The initial assessment was that the patient was just having a psychosomatic reaction (PSR), a benign psychological reaction to the stress triggered by the domestic quarrel, a severe anxiety reaction.

The plan was just to give tranquilizers and send the patient home.

In my half-asleep state, I agreed with the plan, until our resident said, “By the way, Sir, we also noted cold, clammy perspiration.”

That woke me up totally and I deferred the plan to discharge the patient. Cold, clammy perspiration in patients complaining of heart symptoms such as chest pains and difficulty of breathing could indicate a more serious underlying heart problem. We see this a lot in patients having a heart attack or heart failure.

That patient underwent further tests, which all showed abnormal findings similar to a heart attack and heart failure. We suggested a coronary angiogram to see if her arteries were clogged, but they opted not to undergo the test and the patient just requested medications. Fortunately she responded to medications and was discharged symptom-free after several days.

We signed her out as a case of stress-induced cardiomyopathy.

Octopus trap

Symptoms of heart failure triggered by stress are now well documented in medical literatures. It is also called Takotsubo cardiomyopathy, named after the octopus trap called “tako tsubo” in Japan, since the heart assumes a shape similar to the octopus trap—narrow near the opening, and widening at the base or lower portion.

It was first reported by a Japanese physician after he encountered relatively young females presenting unusual cases of sudden heart failure following emotional upset—like breaking up with boyfriends or separating from spouses.

Because of this trigger, some authors labeled it as the “broken heart syndrome” (BHS).

Aside from relationship conflicts, other causes of BHS are grief over the death of a loved one, fear of public speaking, work-related stress, betrayal or romantic rejection, and financial problems.

It has also been reported in those with severe asthma, and those who undergo surgery, chemotherapy for cancer and stroke.

Even happy events

However, in a few cases, even happy events have also been reported to cause it—like a wedding, winning the lotto or excitement in sports event, and during a reunion, birthday or anniversary celebration.

Dr. Ilan Wittstein , a cardiologist at the Johns Hopkins Hospital in Baltimore, Maryland, reported the case of a woman who had to be admitted in the intensive care unit (ICU) on her 60th birthday after she was startled by well-wishers who shouted “Surprise!” The well-meaning well-wishers got the surprise of their lives, too, when the woman landed in the ICU.

Stress is the main factor in BHS, in more than 85 percent of cases. A physically or emotionally stressful event could be identified before the onset of symptoms.

In almost 90 percent of cases, women are usually the ones likely to develop BHS, which has been attributed to a surge of stress hormones, especially adrenaline. This is caused by the sudden stimulation of the sympathetic nervous system, which is also responsible for our “fight or flight” responses.

This makes the heart pump hard and fast, depleting its energy reserves. The heart arteries, both the big and small arteries, can also constrict, impeding the blood flow to the heart muscles.
What is unusual in BHS is that a part of the heart (the apex) shows weakened contraction or pumping, while another part (the base) shows forceful contraction.

The symptoms of BHS actually are the same as those of a heart attack, except that in BHS, there is no evidence of blocked arteries.

A real-life broken heart can actually lead to cardiac complications, proving the established links between depression, mental health and heart disease.

The good news is that patients with BHS recover dramatically, as early as a few days to a few weeks. The recovery period usually takes a longer time when one has a heart attack due to clogged arteries.

So, beware of the “broken heart syndrome.”

If you have severe symptoms, don’t dismiss them as simple stress-related anxiety reaction. Go to the nearest ER. When treated promptly, the “broken heart” can be made “whole” again.

Wishing all our readers a happy Valentine’s Day, and may your hearts be break-proof.