September 21, 2023

Where do broken hearts go? Well, if it’s broken heart syndrome, the answer is typically the emergency room. And according to a study published last month in the Journal of the American Heart Association (JAHA), such trips happened more and more often each year from 2006 to 2017.

Now, true broken heart syndrome is still quite uncommon. In this case, we’re not talking about the rom-com-esque broken heart. It’s not the “why-won’t-Orlando-Bloom-respond-to-me-after-I-sent-him-a-life-sized-chocolate-statue-of-him-as-Legolas” broken heart. Instead, the JAHA study looked at the real medical condition known as broken heart syndrome, Takotsubo cardiomyopathy, or stress-induced cardiomyopathy. It only constitutes about 2% of suspected heart attack cases, as per the Cleveland Clinic website.

That doesn’t mean that broken heart syndrome has nothing to do with emotion. As I’ve covered before for Forbes, broken heart syndrome is when figurative heartache may turn into literal heartache. Takotsubo syndrome (TTS) may occur when some type of emotional stress causes your body to release adrenaline and other hormones. This can be negative stress like losing a loved one, harassment at work, or realizing that the grocery store is completely out of toilet paper. Or it can be more positive stress such as a surprise birthday party or realizing that your birthday gift is rolls of toilet paper. It can also be physical stress like an asthma attack, an infection, or getting pummeled with many rolls of toilet paper.

The resulting hormonal rush can then overstimulate and overwhelm your heart muscles. As is the case with nearly every body part, some stimulation at the right time can be good. Too much can be, well, too darn much.

Overstimulation can cause your heart muscles to essentially poop out and malfunction. This can result in symptoms such as chest pain, shortness of breath, sweating, and dizziness. Of course, these can be quite similar to the symptoms of a heart attack. So, people suffering from TTS tend to end up in the emergency room.

Unlike a heart attack, though, stress-induced cardiomyopathy doesn’t usually result from or cause permanent damage. Treatment involves managing your stress and keeping your blood pressure and heart rate low so that your heart won’t have to work as hard. Such supportive care alone can ensure that “your heart will go on,” with the full return of your normal heart function. Some cases, however, may progress to much more serious stuff, such as congestive heart failure, shock, abnormal heart rhythms (which can lead to stroke) and even death.

For the study, a team from Cedars‐Sinai Medical Center in Los Angeles, CA (Varun K. Pattisapu, Yunxian Liu, Trevor‐Trung Nguyen, Amy Hoang, C. Noel Bairey Merz, and Susan Chen) and the University of Southern California (Hua Hao) examined data from a sample of hospital admissions in the U.S. known as the National Inpatient Sample (NIS) database provided by the Healthcare Cost and Utilization Project. In this sample from 2006 to 2017, the team found 135,463 documented cases of TTS. Of these, most (88.3%) were among women.

During that decade, the number of TTS diagnoses per million hospitalizations per year increased for both men and women across all three age groups studied: less than 50 years of age, 50 to 74 years of age, and 75 years and older. The biggest jump occurred among women from 50 to 74 years of age by 128 cases per million per year. The next biggest jump was among women 75 years and older: by 96 cases per million per year. This was followed by men from 50 to 74 years of age (an increase of 20 cases per million per year), men 75 years and older (16 cases per million per year), women less than 50 years of age (15 cases per million per year), and finally men less than 50 years of age (10 cases per million per year).

So why have diagnoses have been on the rise? Well, part of the reason might be increasing awareness of the diagnosis. After all, doctors won’t typically say, “I believe you have TTS even though I have no idea what that is.” The syndrome didn’t really garner much attention until a study published in 2005 in the New England Journal of Medicine essentially said “what the bleep is this?” So perhaps until this diagnoses caught on in the medical community well after 2005, many cases of TTS might have been called something else.

Nevertheless, there may be a real increase in the incidence of TTS. It could reflect a continuing rise in emotional stress and decreased capacity for dealing with such stress across our society. This wouldn’t be too surprising since many mental health indicators have been going the wrong direction since the beginning of the 1980’s. For example, as I covered previously for Forbes, feelings of loneliness have been increasing over the years.

Why are more women experiencing broken heart syndrome? Well, “hormones” seems to be the stock, knee-jerk response whenever one finds any differences between the sexes. But it’s not yet clear how much hormones may be at play here. And before you claim that women are more “emotional” than men, take a look at a study published in Scientific Reports and covered by Alison Escalante, MD, yesterday for Forbes. This study provided further evidence that men can be just as “emotional” as women. So, gosh darn it, it’s OK if you are a dude and shed some tears when Jumbo was locked away in the movie Dumbo. You can cry if you want to whether or not it’s your party.

Here is a TODAY show segment featuring a man who suffered broken heart syndrome during the Covid-19 pandemic:

More research is needed to determine what may be driving the observed sex differences in TTS incidence. Could it be due to differences in societal expectations and systems that may be putting more pressure on women or paying less attention to their situations? How much of this is really biologically-driven? More research is also needed to determine why the TTS incidence in general is increasing and what should be done to curb such increases.

Again, while broken heart syndrome is by no means a common diagnosis, the increase over time could reflect some broader trends in society. It could be yet another warning bell that systems around us really need to change. After all, if people are experiencing more and more stress and having less and less ability to cope, that could be heart-breaking in more ways than one.