Most people know what a heart attack is — someone in the US has one about every 40 seconds.
But there’s a lesser-known condition that can look nearly identical and sounds like it belongs in a romantic drama: broken heart syndrome, also known as takotsubo cardiomyopathy.
It’s a temporary condition most often triggered by intense emotional or physical stress, such as the loss of a loved one, a major life event or serious illness. Unlike a heart attack, which is caused by blocked blood flow to the heart, broken heart syndrome does not involve permanent damage.
An estimated 1% to 2% of patients who arrive at the hospital with chest pain and electrocardiogram changes that resemble a heart attack are ultimately diagnosed with takotsubo cardiomyopathy.
While cases appear to be rising, it remains unclear whether this reflects improved recognition or a true increase in incidence.
This is what causes broken heart syndrome, who’s most at risk and what recovery looks like.
What causes broken heart syndrome?
Exactly how intense stress leads to sudden heart dysfunction isn’t fully understood.
One leading theory is that a surge of stress hormones — particularly adrenaline — becomes temporarily toxic to the heart muscle.
Another suggests that adrenaline overload forces the heart to contract so powerfully that it essentially “shuts down” in self-defense — much like a child covering their ears and saying, “I’m not listening anymore.”
A related idea is that instead of overworking, the heart responds to the flood of adrenaline by dialing down its function to conserve energy, which may explain why heart function often recovers after the episode.
Another theory proposes that stress causes a cascade of events that triggers the heart’s smallest blood vessels to constrict, briefly limiting blood flow in a way that differs from a classic heart attack.
There are additional hypotheses, and ongoing research continues to better understand these mechanisms.
What are the risk factors?
Broken heart syndrome most commonly affects postmenopausal women. About 90% of cases occur in women, with most patients between the ages of 60 and 75.
The emotional and physical triggers are broad. Emotional stressors can range from the death of a loved one or devastating news to intense worry about something that hasn’t happened yet — or even moments of extreme joy or elation.
Physical stressors may include significant exertion, such as hiking at high altitude or starting a vigorous new fitness program, as well as severe illness or even a traditional heart attack.
What are the symptoms?
Symptoms often resemble those of a heart attack. Chest discomfort is common, though it may not be painful or felt squarely in the chest. Discomfort can also occur in the jaw, neck, shoulders, arms, back or upper abdomen.
Some people also experience shortness of breath, nausea, vomiting, sweating, dizziness or a sudden sense that something is very wrong.
How is it diagnosed?
The priority is ruling out a blocked coronary artery and confirming symptoms are due to takotsubo cardiomyopathy.
Evaluation includes an echocardiogram to assess heart function and look for patterns that suggest a heart attack. We also perform a troponin blood test, as elevated troponin can signal heart muscle injury.
To definitively rule out blocked arteries, patients usually undergo cardiac catheterization with coronary angiography, which allows us to visualize the inside of the coronary arteries.
What does recovery look like?
Broken heart syndrome is a relatively newly recognized condition, and large clinical trials are limited. Still, what we’ve learned from observational studies is encouraging.
Certain medications, including ACE inhibitors and angiotensin receptor blockers (ARBs) — commonly used to treat high blood pressure — may help lower the risk of broken heart syndrome. Beta blockers have also been shown to help reduce recurrence.
For most people, broken heart syndrome is a one-time event. Recurrence occurs in about 1% to 5% of patients. Encouragingly, in most cases, heart function typically returns to normal within a few weeks to two months.
What are the misconceptions about broken heart syndrome?
One common misconception is that broken heart syndrome is always caused by severe emotional trauma. In reality, triggers can be subtle, cumulative or even positive.
Joyful or exciting events can also place significant stress on the body.
Another is the belief that patients caused the condition by failing to control their emotions. Stress responses are deeply ingrained biological processes — not personal failings — and no one should blame themselves for developing a physical condition triggered by stress.
Finally, although it often comes on suddenly, takotsubo cardiomyopathy can also develop in response to chronic, accumulating stress — not just a single dramatic moment.
What’s next?
My team at NYU Langone Health continues to study takotsubo cardiomyopathy to better understand why it occurs and how to prevent it.
Some patients appear to have a mild form of hypertrophic cardiomyopathy, a genetic heart condition, which may increase susceptibility — though why only some go on to develop broken heart syndrome remains unclear.
Ongoing research is also exploring stress-management strategies to help regulate the body’s response to everyday stressors, not just major life events.
While there’s still more to learn, we’ve already made meaningful progress. Over time, we’ve gained important insights into prevention and treatment and the best ways to support patients through recovery.
At NYU Langone Health, women’s heart health is a particular focus — and patients are never navigating this journey alone.
Harmony R. Reynolds, MD, is an internationally recognized cardiologist and director of the Cardiovascular Clinical Research Center in the Department of Medicine’s Leon H. Charney Division of Cardiology at NYU Langone Health. Her clinical and research focus is heart disease in women, focused not only on heart attacks, but also the prevention of heart disease.
