Broken Heart Syndrome (Takotsubo Syndrome): Stress and Heart Health Facts

Broken Heart Syndrome (Takotsubo Syndrome) is a temporary heart condition that can occur after intense emotional or physical stress. Also known as stress cardiomyopathy, it can cause sudden chest pain, shortness of breath, and other symptoms that closely resemble a heart attack.

Because broken heart syndrome can feel exactly like a heart attack, it is important to treat new chest pain or shortness of breath as an emergency. If you think you may be having a heart attack, call 911 right away.

Chronic stress affects more than emotional well-being. It can disrupt the immune, digestive, sleep, reproductive and cardiovascular systems, increasing the risk of heart-related symptoms and conditions. February is American Heart Month, a time to raise awareness about how stress and lifestyle factors impact heart health.

Amir Lotfi, MD, chief, Division of Cardiology at Baystate Health, answers some common questions about how stress affects the heart, what broken heart syndrome is, and when to seek medical care.

How Stress Increases Heart Disease Risk

“Studies have shown how risk factors such as smoking, obesity, high cholesterol, high blood pressure and diabetes can lead to cardiovascular disease. While there is a lack of conclusive data, we know there is an association between emotional stress levels and increased rates of heart attacks,” said Dr. Lotfi.

He cited a study by Harvard Medical School researchers published in the British health journal Lancet. It described how increased activity in the amygdala, a brain region involved in processing intense emotions, has been associated with inflammation in the blood vessels and increase of cardiovascular events.

Can Stress Cause a Heart Attack?

Stress can cause physical effects including headaches, upset stomachs, muscles aches, and insomnia. Stress can also cause high blood pressure, which is puts you at risk for heart attack and stroke. Experts also say that stress can increase harmful activities like overeating and smoking — also risk factors for heart disease.

Stress can also make you feel like you’re having a heart attack even if you’re not.

“We also know that stress can cause chest pain that isn’t necessarily associated with having a heart attack. Anxiety can increase the body’s stress hormones, cause hyperventilation, and an increased risk of muscle spasms. This can lead to similar symptoms as a heart attack and it can be difficult to distinguish chest pain due to impaired blood flow to the blood vessels of the heart compared to chest pain due to anxiety or other causes,” Dr. Lotfi said.

What is Broken Heart Syndrome (Takotsubo Syndrome)?

Broken heart syndrome is a sudden, usually temporary change in how the heart’s main pumping chamber (the left ventricle) squeezes. It often happens after a major stressor. The condition can cause chest pain, shortness of breath, abnormal ECG findings, and blood test changes that look like a heart attack.

Unlike a typical heart attack, broken heart syndrome is usually not caused by a blocked coronary artery. However, some people with this condition can also have coronary artery disease, so doctors still need to evaluate for a heart attack.

What Triggers of Broken Heart Syndrome?

Emotional triggers may include:

• Grief or loss of a loved one
• Relationship conflict or divorce
• Financial stress or job loss
• Sudden fear, anger, or shock

Physical triggers may include:

• Serious illness or infection
• Major surgery or injury
• Severe asthma or COPD flare
• Neurologic events such as stroke or seizure

Symptoms of Broken Heart Syndrome

Symptoms can be the same as a heart attack. Seek emergency care for:

• Chest pressure, tightness, or pain
• Shortness of breath
• Fainting or near-fainting
• New palpitations or a racing heartbeat
• Sudden severe weakness, sweating, nausea, or dizziness

Can Stress Cause a Heart Attack?

Stress does not directly “clog” arteries. But both sudden stress and long-term stress can raise blood pressure, increase heart rate, and affect inflammation and blood clotting. In people who already have plaque in their coronary arteries, this extra strain may contribute to a true heart attack.

Stress can also lead to habits that increase cardiovascular risk over time, such as poor sleep, overeating, smoking, inactivity, and missed medications.

How Doctors Diagnose Broken Heart Syndrome?

Because symptoms mimic a heart attack, clinicians usually start by ruling out blocked arteries. Tests may include:

• Electrocardiogram (ECG) and blood tests (such as troponin)
• Echocardiogram (ultrasound of the heart)
• Coronary angiography (heart catheterization) or CT coronary angiography
• Cardiac MRI in selected patients

Treatment and Recovery for Broken Heart Syndrome

Treatment depends on how sick someone is and whether complications develop. Many patients are treated with medications used for heart failure while the heart recovers.

Commonly used treatments may include:

• Beta-blockers
• ACE inhibitors or ARBs
• Diuretics (“water pills”) if fluid builds up
• Treatment of the stress trigger (for example, managing pain, infection, or anxiety)

Most people improve in days to weeks, and heart function often returns close to normal within about one to two months. Your clinician may recommend repeat imaging (often an echocardiogram) to confirm recovery.

Serious complications are uncommon but can include heart failure, dangerous rhythm problems, blood clots, or cardiogenic shock. Recurrence can happen, so follow-up care matters.

According to the National Institute of Mental Health, if you take practical steps to manage your stress, you may reduce the risk of negative health effects.

How to Reduce Stress and Protect Your Heart

These steps can help many people lower stress and improve heart health:

1. Get Regular Exercise

Just 30 minutes per day of walking can help boost your mood and improve your health.

2. Prioritize Sleep and Keep a Consistent Schedule

Getting enough quality sleep helps regulate stress hormones and supports heart health. Try to go to bed and wake up at the same time each day when possible.

3. Limit Alcohol and Avoid Nicotine

Alcohol and nicotine can increase heart rate, raise blood pressure, and add stress over time. Avoiding tobacco and alcohol can significantly reduce cardiovascular risk.

4. Try a Relaxing Activity

Explore relaxation or wellness programs, which may incorporate meditation, mindfulness, muscle relaxation, or breathing exercises. Schedule regular times for these and other healthy and relaxing activities.

5. Stay Connected with Supportive People

Strong social connections provide emotional support and can help the effects of stress. Reach out to friends, family, or community groups regularly.

6. Talk With Your Clinician About Mental Health Support

If stress, anxiety, or depression feel difficult to manage, counseling or therapy can be an important part of protecting both mental and heart health.

When to Seek Medical Care

Contact your primary care clinician or cardiologist if you have ongoing symptoms, questions about medications, or difficulty managing stress. If you have chest pain, shortness of breath, or fainting, seek emergency care.

“Don’t let stress overtake you. If you are feeling overwhelmed, talk to your healthcare provider who can discuss treatments that can help ease your stress and help to keep you out of the cardiologist’s office,” said Dr. Lotfi.