When the heart breaks

Countless songs, poems and movies have dealt with it - the pain from a broken heart. We have read of, or even know, couples who died within weeks of one another, with the family saying the widow or widower died from a broken heart.

Most of the time, we think "broken heart" does not exist. However, research shows that the condition is not a myth. It is recognised as a medical condition. Known as broken heart syndrome, or Takotsubo cardiomyopathy, it was first reported by Japanese researchers in 1990.

They found that people who had suffered from severe emotional and physical traumas displayed symptoms similar to that of a heart attack. An emotional trauma causes severe heart muscle weakness which can lead to congestive heart failure, low blood pressure, shock and potentially life-threatening heart rhythm abnormalities.


Sime Darby Medical Centre consultant cardiologist Dr Betty Teh says as broken heart syndrome shows similar symptoms to that of a heart attack, it is difficult to diagnose. "When you investigate the condition, you won't find blockage or history of heart disease. But the heart is not functioning well.

And the movement of the heart is specific. It is different from other heart failures. "The disease has to be investigated with the help of an echocardiogram. Through the test, we can see changes in the heart muscle.

When you diagnose broken heart syndrome, it is diagnosis per exclusion. What this means is that you don't see any of the normal reasons for heart failure and so it could be the disease."


According to University of Nebraska Medical Centre, the syndrome is characterised by the unique contraction pattern of the heart when viewed by echocardiogram.

While the base of the heart's main pumping chamber contracts normally, there is a weakened contraction in the middle and upper portions of the muscle. Other characteristics include a distinctive pattern on electrocardiogram.

Dr Teh, who has never treated the condition, says broken heart syndrome is rare and that it affects women, especially those in post-menopausal age.

When a person suffers emotional trauma, the body releases large amounts of the hormone catecholamines. The hormone is produced when our body experiences severe stress, trauma or fear, which results in the heart beating erratically. This leads to chest pain, shortness of breath and ballooning of the heart muscle.

A study by Johns Hopkins in 2005 found that when a person suffers from sudden, overwhelming emotional stress, the body releases catecholamines into the blood stream, along with its breakdown products and small proteins produced by an excited nervous system.

These chemicals can be temporarily toxic to the heart, effectively contracting the muscle and producing symptoms similar to a heart attack, including chest pain, fluid in the lungs, shortness of breath and heart failure.

Good chances of recovery


Dr Teh says fortunately the progression of the disease can be self-limiting, with low mortality rate. Once there is recovery, the chances of it happening again is rare.

"There is a small risk that patients may die in hospital when they present themselves with the condition. However, once they are discharged, the survival rate is 100 per cent."

She says while there is no data of broken heart syndrome in Malaysia, the UK records 300,000 cases of heart attack every year. Out of this, less than two per cent is due to broken heart syndrome.

"It could also be because some doctors are unaware of such a condition and treat it like a heart attack. So we wouldn't know it is broken heart syndrome unless the doctor picks up on it. It is about awareness when you make a diagnosis. With better understanding, awareness will increase."


1. Takotsubo cardiomyopathy is also known as:

  • neurogenic myocardial stunning
  • stress cardiomyopathy
  • stress-induced cardiomyopathy
  • transient left ventricular apical ballooning
  • "ampulla" cardiomyopathy
  • "broken heart syndrome"

2. Takotsubo is Japanese for "octopus traps" that fishermen still use. In this syndrome, the heart (left ventricle) takes the shape of an octopus trap (takotsubo).

3. A diagnosis of takotsubo syndrome can only be made after excluding:

  • coronary artery disease (especially proximal left main or left anterior coronary artery stenosis)
  • acute coronary syndrome
  • acute myocardial infarction
  • myocarditis, pericarditis and aortic dissections