Stress is a well known, major risk factor for heart disease. There are two types of stress – chronic and acute stress. Chronic stress, our response to day to day “stressors” can have profound effects on blood pressure, blood glucose, cholesterol levels, blood clotting and increase the risk of heart attacks, strokes and chronic conditions like obesity, diabetes, Alzheimer’s disease and even cancer. 

Acute (sudden, severe) stress can result in symptoms that resemble a heart attack and transient weakness of the heart. In fact, even to the trained medical eye, it looks exactly like a heart attack. The symptoms are similar, patients complaining of chest pain and shortness of breath. The ECG (electrocardiogram) has the same abnormalities as a heart attack and the biomarkers in the blood are likewise abnormal. The big difference is that, unlike a heart attack, when these patients undergo cardiac catheterization (as they should), their coronary arteries are normal without a significant blockage to explain a heart attack. And, the weakness of the heart is only temporary. 

So how do we explain this? STRESS! 

Broken heart syndrome, also known as stress-induced cardiomyopathy, apical ballooning syndrome and Takotsubo cardiomyopathy is a rare syndrome that mostly affects women (88%) and occurs in response to intense psychological or physical stress. 

A little medical terminology may be helpful here to better understand the science. 

CARDIOMYOPATHY– weakness and dysfunction of heart muscle 

TAKOTSUBO – The shape of the heart in this syndrome is described as being similar to a pot Japanese fisherman used to catch octopus, called a takotsubo.

APICAL BALLOONING – The tip of the heart, referred to as the apex, which is commonly involved, becomes enlarged and weak, ballooning out with each heartbeat. 

STRESS-INDUCED CARDIOMYOPATHY– This name explains (to a certain degree) the mechanism of injury to the heart – stress. More specifically, the stress response leads to a surge of catecholamines such as adrenaline which when overproduced can be toxic to the heart.

What kinds of stress can trigger a broken heart syndrome?

Broken heart syndrome is often preceded by an intense physical or emotional event. Some potential triggers of broken heart syndrome are:

  • The death of a loved one
  • News of a frightening medical diagnosis
  • Domestic abuse
  • Strong arguments
  • Public speaking
  • Job loss or financial difficulty
  • Divorce, breakup, betrayal
  • Surprise party
  • Good news, like winning the lottery
  • Physical stressors, such as an asthma attack, COVID-19 infection, a broken bone or major surgery

It’s also possible that some drugs, rarely, may cause broken heart syndrome by causing a surge of stress hormones. Drugs that may contribute to broken heart syndrome include:

  • Epinephrine (EpiPen, EpiPen Jr.), which is used to treat severe allergic reactions or a severe asthma attack
  • Duloxetine (Cymbalta), a medication given to treat nerve problems in people with diabetes, or as a treatment for depression
  • Venlafaxine (Effexor XR), a treatment for depression
  • Levothyroxine (Synthroid, Levoxyl), a drug given to people whose thyroid glands don’t work properly
  • Unprescribed or illegal stimulants, such as methamphetamine and cocaine

 

Treatment and Prevention

The good news is that, like with most broken hearts, time heals. Patients are treated acutely with medications for their symptoms and the weakness of the heart (cardiomyopathy). In my experience, I’ve seen improvement in the heart function before they even leave the hospital. There is no good long-term data regarding treatment and given the rarity of this condition, there is no data on prevention either. 

But, what about relaxation techniques such as yoga and meditation for this stress-induced cardiomyopathy? There is an abundance of scientific studies supporting the numerous health benefits of yoga and meditation on heart health, depression and anxiety and many other medical conditions. Did you ever wonder, “how does meditation protect my heart?” 

The Stress Response/Relaxation Response in a nutshell

The brain responds to stress by releasing the stress hormones, adrenaline, noradrenaline and cortisol. The stress hormones are responsible for the fight or flight response that occurs if our brain perceives danger. This response is controlled by the sympathetic nervous system (SNS). These hormones act upon every organ in our bodies, especially the heart which is called upon to increase blood flow to vital organs. The effects on the heart include an increase in the blood pressure, elevated heart rate and increased pumping of the heart. 

Once the perceived danger is gone, the relaxation response turns down the SNS and cranks up the parasympathetic nervous system (PNS) resulting in lower levels of stress hormone, lower heart rate, blood pressure, respiratory rate and improved sense of calm. The negative effects of “stress” on our health occur if there is an excess of stress hormones or chronic, persistent release of the stress hormones when in fact there is no real danger, just what we perceive in our daily lives as “stress”.

Meditation trains your mind to become less responsive to stress, resulting in lower levels of the stress hormones, like adrenaline and cortisol, in your blood and counteract the harmful effects of stress throughout the day. Relaxation practices such as yoga, tai chi, breathing exercises, mindfulness and meditation teach us how to cope with stress, and building resilience against stress reduces our risk of heart disease and so much more.

So I think we can posit that building resilience and coping mechanisms can only help us in those moments of dire stress, those horrific moments that in some individuals may lead to a “broken heart”. Acute stress is unanticipated, has a sudden onset, and is short in duration. Techniques to calm your mind and improve the quality of your mental and physical health can only help. Are you ready to de-stress? Why not try one of the many free meditation apps available on your cell phone. Put that device to good use. If you’ve never meditated before, why not give it a try. You don’t need any special equipment. You don’t have to sit cross-legged on the floor. Sit in a chair and listen to a short guided meditation. And then, pay attention to how you feel. 

What do you have to lose? Stress, anxiety, indecision, illness

 What do you have to gain? Equanimity, peace, calm, improved memory, more energy and health

 

Wishing you peace, health and happiness

Millie Lee, MD, FACC