It turns out that a broken heart can actually kill

Joe Garcia, 50, was preparing the funeral rites of his wife, two days after she was gunned down at the Robb Elementary School Shooting in Texas, United States, on May 24, 2022 when he collapsed and died, due to broken heart syndrome.

Otherwise known as Takotsubo cardiomyopathy, broken heart syndrome occurs when an extremely traumatic event triggers a surge of stress hormones, especially adrenaline, resulting in potentially deadly heart failure.

Consultant Cardiologist, Dr Rohit Khurana with the Harley Street Heart and Vascular Centre

Consultant Cardiologist, Dr Rohit Khurana with the Harley Street Heart and Vascular Centre

Consultant Cardiologist, Dr Rohit Khurana with the Harley Street Heart and Vascular Centre says that when one experiences a stressful event brought on by immense grief, fear, anger or shock, the body will release a surge of adrenaline to help you cope with the stress.

“Unfortunately, excessive adrenaline can cause the small arteries in the heart to narrow, causing a temporary decrease in blood flow to the heart. In other cases, adrenaline may bind to the heart cells, which causes a large amount of calcium to enter the cells, preventing the heart from beating as effectively as it should,” says Dr Khurana.

Post-menopausal women at higher risk

Although broken heart syndrome has been reported in men and even in children, post-menopausal women are most at risk.

According to a study published in the American Journal of Cardiology, more than 88% of all cases were among women, with diagnoses for the condition increasing six to 10 times more rapidly in women aged 50 to 74 than any other demographic.

Why post-menopausal women are most affected is unclear, but Dr Khurana believes that lower levels of oestrogen, which otherwise helps protect the heart from the harmful effects of adrenaline, may be partly to blame.

One of Dr Khurana’s recent patients was an 80-year-old lady who lived in India alone and was finally able to travel to Singapore to see her family, after being separated for two years due to the pandemic.

“On the flight, she was so anxious that she became disoriented and requested for the cabin staff to ask the pilot to turn back. When she arrived at our A&E, she was put through various invasive emergency assessments and was diagnosed with broken heart syndrome. Checks indicated she had suffered a heart attack-like event triggered by acute distress during the flight,” Dr Khurana shares.

In addition to age, gender and psychological stressors, other risk factors for broken heart syndrome include smoking and mental health disorders, such as chronic anxiety and depression.

Symptoms and diagnosis for broken heart syndrome

Symptoms of broken heart syndrome are similar to that of a heart attack, such as chest pain, shortness of breath, sweating and dizziness.

If patients experience any of these symptoms immediately, or a few hours, especially after a particularly stressful event, Dr Khurana suggests visiting a cardiologist to undergo various tests to confirm the diagnosis. The recommended checks include:

  1. Electrocardiogram (ECG) – This quick, non-invasive test can diagnose broken heart syndrome by looking for ECG changes that mimic that of an acute heart attack.
  2. Coronary angiogram – During this diagnostic procedure, dye is injected into the blood vessels of the heart to check if there are blockages. People who have had a heart attack normally have a blockage that shows up on the angiogram. If the vessels are clear, this could indicate that the patient has experienced broken heart syndrome.
  3. Echocardiogram – This non-invasive test uses sound waves to create images of the heart’s structure and motion. A heart which is enlarged or have an unusual shape could indicate broken heart syndrome.
  4. Blood tests -Patients with broken syndrome often have higher levels of cardiac enzymes in the blood.

How can you mend a broken heart?

While many of us will experience heartbreak and stress at some point in our lives, dying from a broken heart is highly unlikely, and only happens in about 1% of all patients with the condition. The other good news is that broken heart syndrome is also highly treatable, with patients making a full recovery within weeks of being diagnosed.

“Once broken heart syndrome and its severity is confirmed, it is usually treated with medications including ACE inhibitors to reduce blood pressure, beta blockers to slow the heart rate and reduce the effects of adrenaline and other stress hormones, plus anti-anxiety medications to manage stress. I may also recommend cardiac rehabilitation, depending on how much the heart has weakened,” says Dr Khurana.

“In most cases, patients will recover between three to seven days and will usually regain normal heart function within a month,” he adds.

Keep your heart healthy and happy

Taking steps to manage stress and other risk factors can help lower the risk of future episodes. Some of Dr Khurana’s recommendations include:

Managing stress: Try activities such as meditation, progressive muscle relaxation, visualisation or deep breathing. Where possible, avoid or reduce encounters with people or situations that can trigger deep emotional reactions, such as anger. If you are unable to manage stress on your own, consult a mental health professional.

Exercising: Exercise is an excellent stress-reliever because it releases endorphins, which are known as ‘feel good’ hormones. If pounding on the pavement or treadmill is not your cup of tea, have a go at other fun activities like dancing, yoga, or cycling.

Quitting smoking: Although you may feel relaxed when you smoke as nicotine releases dopamine in your brain, your body is experiencing increased stress; your blood pressure elevates and your muscles tense, while your body and brain receive decreased levels of oxygen. The feelings of relaxation are also short-lived, and it is only a matter of time before your brain nudges you to light up again for your hit of dopamine.