Is a Broken Heart a Real Medical Event?

Feb. 10, 2005 — -- Is there really such a thing as a broken heart?

A study published today in the "New England Journal of Medicine" suggests there may be. The article claims that an emotionally stressful situation, such as a loved one's unexpected death, may actually cause the symptoms of heart failure in some people.

Researchers at Johns Hopkins University in Baltimore examined 19 individuals with no prior medical problems who showed symptoms of stress cardiomyopathy -- chest pain, difficulty breathing or low blood pressure -- following a stressful event.

A series of exams, including blood tests and angiograms, revealed that all of the subjects had a severe dysfunction of the left side of the heart. The same tests performed two to four weeks later, however, indicated that these defects had completely resolved.

The investigators noticed that these individuals had abnormally high levels of stress hormones, which can be toxic to the heart muscle. They hypothesized that this temporary weakening of the heart muscle may be triggered by the stress hormones.

A Real-Life 'Broken Heart'

The lead author of the study, Dr. Ilan Wittstein, notes that although the "potentially lethal consequences of emotional stress are rooted in folk wisdom, as reflected by phrases such as 'scared to death,'" the study gives credibility to the idea of a real-life broken heart.

Reversible heart damage seen in times of emotional stress is not nearly as common as a true heart attack, which results in permanent damage to heart muscle. But the phenomenon is real, and it hadn't been formally recognized by any American studies until Wittstein and his colleagues described it.

Dr. William Abraham, chief of cardiovascular medicine at Ohio State University in Columbus, said the theory about stress hormones "is a biologically plausible explanation for unexplained heart failure in previously healthy people."

Recognition by the Medical Community Is Rare

The phenomenon of stress-related heart problems is not a new matter, but it has perhaps been under-recognized until now.

"With all of this publicity," said Wittstein, "doctors will start to recognize this syndrome more often, and we can reassure patients that we know what this is, and the outcome will be all right."

The authors write, "When medical support is provided initially, patients with stress cardiomyopathy have rapid … improvement and have an excellent prognosis."

The study found that, four years later, none of the subjects had died or had a recurrence of heart problems.

"Many doctors tend to discount the role of severe stress in heart disease," said Abraham. He explained that stress on its own, whether emotional or physical, is a risk factor for traditional coronary artery disease, and it also tends to cluster together with other known risk factors like smoking, a fatty diet and lack of exercise.

"This hits close to home," said Abraham, "because these were otherwise healthy people."

Everyday Stress Management Is Key

Dr. Noel Bairey-Merz, medical director of the Women's Health Program at Cedars-Sinai Medical Center in Los Angeles, says "prevention is the key with heart health."

She advises that along with eating a healthy diet, exercising and not smoking, people should incorporate some form of stress management like yoga or meditation into a daily routine.

"Stress management can alter nerve endings to the heart in a beneficial way," said Bairey-Merz, adding that people who have outlets are better conditioned to handle a sudden stressful situation.

Emotional stress is practically unavoidable in everyday life, and experts generally agree it would be unrealistic to advise patients not to feel stress when they are facing a loved one's death or an emergency.

But Abraham advises, "Everything in moderation, including stress."

Bairey-Merz emphasizes that a regular stress management regimen is "like driving in your car with the seatbelt and airbags." Though there is no way to predict who will suffer temporary heart damage related to a stressful event, a stress management system is there in case a heartbreak does arise.