Stick 'em up! A traumatic experience like a robbery can literally break your heart.

What Becomes of the Broken-Hearted?

Common wisdom has it that sad or shocking experiences can literally break your heart. Now, a new study suggests that "broken heart syndrome," whose symptoms resemble those of a heart attack, may be the result of a massive surge of stress hormones caused by a traumatic experience.

Several studies over the past decade have shown that a strong emotional shock can lead to sudden heart failure in people with no known risk factors for heart disease. How that could possibly happen was unclear. Cardiologist Ilan Wittstein at the Johns Hopkins School of Medicine in Baltimore, Maryland, and his colleagues studied 19 patients who were hospitalized with heart problems shortly after an emotional event, such as a court appearance, an armed robbery, or the death of a loved one.

Their symptoms, including chest pain, fluid in the lungs, and shortness of breath, resembled those of a classic heart infarction, caused by a clogged blood vessel. But a range of tests showed they were suffering from something else. Angiograms revealed no blockages of the arteries, for instance, and the researchers didn't find elevated levels of enzymes released by damaged heart tissue. Moreover, all patients recovered within 2 weeks, a far better outcome than for infarction.

Levels of stress hormones like adrenaline and noradrenaline, however, were 3 to 4 times higher than those in classic cases of heart attacks, and 7 to 34 times higher than those in healthy people. Echocardiograms revealed a contraction pattern not seen in infarctions: The base of the heart's main pumping chamber, the left ventricle, seemed to work just fine, but contraction was weakened in its medium and upper parts. The researchers, who report their findings online this week in the New England Journal of Medicine, believe the flood of stress hormones may temporarily stun the heart muscle, although they have yet to show how this happens or why 18 of the 19 patients were women.

"It's an excellent paper," says cardiologist Dominique Pavin of the University Hospital in Rennes, France, who was the first to describe two of these patients in a 1997 paper. It's important that doctors recognize the condition, Pavin says, because that allows them to reassure patients that they will be fine. That stress hormones cause the problem yet needs to be proven but "seems very plausible," adds Peter Kowey of Lankenau Hospital and Medical Research Center in Wynnewood, Pennsylvania, who described a similar case in 1998.

Related sites
Pavin's 1997 paper
Kowey's 1998 paper, 'A broken heart'