Gender-based research has shown that in matters of the heart, sex differences abound.

One striking example is the transient heart condition known as “broken-heart syndrome”. In this condition, more than 90 per cent of reported cases are in women aged 55 to 75 years.

Research suggests that at least six per cent of women evaluated for a “heart attack” actually have this disorder, which has only been recently reported in the United States and may go largely unrecognised. Fortunately most people recover rapidly, with no long-term heart damage.

What is broken-heart syndrome?

It is also known as Takotsubo cardiomyopathy, or apical ballooning syndrome, after its first official description in Japan in 1990. It is a weakening of the heart left chamber muscle or left ventricle (the main pumping chamber), usually as a result of severe emotional or physical stress, such as a sudden illness, loss of a loved one, a serious accident, or a natural disaster like an earthquake. That’s why the condition is also called: stress-induced cardiomyopathy.

What is the cause of broken heart syndrome?

The precise cause isn’t known, but experts think that surging stress hormones (for example, adrenalin) essentially “stun” the heart, triggering changes in its muscle cells or coronary blood vessels (or both) that prevent the left ventricle from contracting effectively.

Researchers suspect that older women are more vulnerable because of reduced levels of oestrogen after menopause. In studies with rats whose ovaries had been removed, the ones given oestrogen while under stress had less left ventricle malfunction and higher levels of certain heart-protective substances.

What are the manifestations of broken heart syndrome?

The symptoms are indistinguishable from those of a heart attack, and include mainly chest pain and shortness of breath. An electrocardiogram may show abnormalities also found in some heart attacks, in particular, changes known as ST-segment elevation.

On blood tests, and heart attacks also, a rapid but usually smaller rise in cardiac biomarkers is seen (substances released into the blood stream when the heart is damaged).

Consequently, imaging studies, like an echocardiogram or an angiogram, are needed to rule out a heart attack. The echo (ultrasound image) could highly tilt the diagnosis toward Takotsubo cardiomyopathy by showing bulging or ballooning of the lower part of the left ventricle (apex).

During contraction (systole), this bulging ventricle resembles a takotsubo, or a pot used by Japanese fishermen to trap octopuses, hence the name.

To get a definitive diagnosis, clinicians look for the absence, on a coronary angiogram, of significant blockages in the coronary arteries, the most common cause of heart attacks.

What is the treatment of broken heart syndrome?

There are no evidence-based guidelines for treating stress cardiomyopathy. In the immediate setting, clinicians usually recommend standard heart failure medications such as betablockers, Ace inhibitors, and diuretics (water pills).

Although there’s little evidence on long-term therapy, beta blockers or combined alfa and beta blockers may be continued indefinitely to help prevent recurrence by reducing the effects of adrenalin and other stress hormones. It’s also important to alleviate any physical or emotional stress that may have played a role in triggering the disorder.

Most of the abnormalities in the left ventricle wall movement clear up in one to four weeks, and most patients recover fully within two months.

Rarely reported complications include arrhythmias (abnormal heart rhythms), low blood pressure, rupture of the ventricle wall, and death.

Former NFL pro bowler Doug Flutie announced last November that his mom suffered broken heart syndrome and died within an hour of his father, who succumbed to a traditional heart attack. They had been married for 56 years!

• Joe Yammine is a cardiologist at Bermuda Hospitals Board. He trained at the State University of New York, Brown University and Brigham and Women’s Hospital. He holds five American Board certifications. He was in academic practice between 2007 and 2014, when he joined BHB. During his career in the US, he was awarded multiple teaching and patients’ care recognition awards. The information herein is not intended as medical advice nor as a substitute for professional medical opinion. Always seek the advice of your physician. You should never delay seeking medical advice, disregard medical advice or discontinue treatment because of any information in this article.