Anyone who has been through a bad breakup, lost a loved one, or moved across the country away from family and friends, knows the emotional intensity with which these losses take a hold of us. And there are physical responses to this metaphorical heartache.

Recently, 28-year-old Koby Soto quantified the extreme physical response we have to loss when his Fitbit captured his spiking heart rate following a breakup. Immediately after his boyfriend called it quits, his heart rate jumped up from 72 to 88 beats per minute, and it remained elevated for the rest of the day, peaking at 118.

"Truth is the force that guides us to where we need to be in life, but love is the power that heals us once we arrive there." - Elizabeth Gilbert

And in rare, but serious, cases the figurative broken heart can become a literal heartache. Not only spurred by a break-up, divorce or death, but incited by extreme positive emotions as well.

For Annie Walker it was the excitement of meeting a distinguished politician she had long admired.

“I had been looking forward to his arrival all day, and finally, there he was, sitting on the sofa…I could feel my chest tighten, but paid no attention,” she said. “Then the tightness intensified and became painful. I got up and clutched my chest, muttering about pain, and walked to our bedroom and lay down, wondering what was going on. My husband called an ambulance and the medics arrived soon afterwards.”

But what exactly is happening in the body when an emotionally intense event like a breakup or finally meeting someone you have long revered leaves you clutching your chest in physical pain?

What is Broken Heart Syndrome?  

Also known as stress-induced cardiomyopathy, Broken Heart Syndrome is rapid and severe heart muscle weakness; the weakness causes a part of the heart to have difficulty pumping, while the rest of the heart remains in normal activity. First identified in Asian populations in 1990, the syndrome was dubbed takotsubo cardiomyopathy, after the term for an octopus trap, whose shape resembles the bulging appearance of the heart during this condition.

At the root of the condition is stress, which triggers a slew of physiological responses in the body.

“One of the assumptions, because it’s still unclear as to what causes it, is that it happens when stress-induced hormones are created after a sudden stressful event such as a death of a loved one or a separation or breakup of a relationship,” said Larry Shushansky, Rhode Island-based psychotherapist. Other emotionally stressful events like a death, job loss, prolonged anxiety, domestic violence, and physical trauma like asthma attacks or a car accident can also induce the syndrome. It may also happen as a result of a positive event that incites extreme emotion, like winning the lottery.

This response starts with the brain: a distress signal is sent to the hypothalamus, an area of the brain that functions like a command center, communicating with the rest of the body through the nervous system. Our nervous system controls involuntary functions like breathing, blood pressure, heartbeat, and the dilation or constriction of key blood vessels. So it’s no surprise that there are physical ramifications to our body processing emotional stressors like grief, fear, extreme anger, and surprise.

When the adrenal glands receive the signals from the hypothalamus, they respond by pumping the hormone epinephrine into the bloodstream, according to the Harvard Medical School. This symptoms of this process is what Soto’s Fitbit documented: “As epinephrine circulates through the body, it brings on a number of physiological changes. The heart beats faster than normal, pushing blood to the muscles, heart, and other vital organs. Pulse rate and blood pressure go up.”

According to Johns Hopkins Medicine, when stress-induced cardiomyopathy occurs, experts believe that the heart muscle is overwhelmed by the massive amount of adrenaline that is suddenly produced in response to stress.

It Feels Like You’re Having a Heart Attack—But You’re Not

The syndrome is characterized by sudden, intense chest pain–so intense, that it’s often misdiagnosed as a heart attack. “In fact, tests show dramatic changes in rhythm and blood substances that are typical of a heart attack. But unlike a heart attack, there’s no evidence of blocked heart arteries in broken heart syndrome,” according to the American Heart Association (AHA).

Chest pain and shortness of breath are the most common symptoms associated with the experience, which is what leads many, like Walker, to believe they are experiencing a heart attack.

“What were they saying? Heart attack? Me? I had never had any problems with the old ticker,” remembered Walker. “My BMI was almost in single figures, I never smoked, I sat down only to write e-mails.”

But once she arrived at the hospital it became clear that it wasn’t a heart attack she was suffering from, but Broken Heart Syndrome.

“I was hooked up to monitors, had blood taken, was tested, scanned, MRI’d, peered at by fabulously beautiful and clever junior doctors…and then, having found nothing wrong, apart from a curiously shaped left ventricle, they concluded that I had had a takotsubo heart attack.”

Doctors are able to identify the recently recognized medical condition as something other than a heart attack through diagnostic tests like blood tests, an EKG and an echocardiogram, which reveal some key differences.

Like in Walker’s Case, the tests will show a ballooning and unusual movement of the lower left heart chamber. Besides this, there are two notable differences between the two conditions: Most patients experiencing Broken Heart Syndrome have fairly normal coronary arteries and don’t have severe blockages or clots (whereas those who suffer a heart attack show blockages and blood clots in the coronary arteries). Secondly, “the heart cells of patients with stress cardiomyopathy are ‘stunned’ by the adrenaline and other stress hormones, but not killed as they are in heart attack,” said Johns Hopkins Medicine. 

Evolutionary Biology: Why Women May Be More at Risk

In 2012, 6,230 people were hospitalized for broken-heart syndrome, according to a study published in The American Journal of Cardiology: and post-menopausal women made up the majority of incidents. Women accounted for more than 90 percent of the cases, and the majority of the attacks happened to people between the ages of 65 to 84 years old.

But why women?

The theory of evolutionary biology, and its reasoning for how each gender approaches relationships, provides a possible explanation for why women seem to be more susceptible to a literal and metaphorical broken heart.

Females nearly always pay a higher price for reproduction, which results in them being relatively more selective in their choice of mates,” concluded Robert L. Trivers, an evolutionary biologist. And although gender roles when it comes to dating have become greatly nuanced (and the conversation doesn’t take sexual preference into account), studies have supported this notion that women are more reticent about entering short-term relationships and more selective about the minimum characteristics they will accept in a partner for such relationships.

So the argument can be made that biologically speaking, the stakes for women are higher. Which may mean they are more likely to take relationships to heart, leaving them more strongly affected by the loss.

A recent study, led by Craig Morris, a professor of anthropology at Binghamton University, found that women experience greater negative side effects following a breakup, experiencing more emotional and physical pain.

But that doesn’t mean men are immune. Increased awareness around the condition has led to more diagnosis of not only men, but younger individual as well (even children).

A new study published in The American Journal of Cardiology found that those who suffer from broken-heart syndrome often have an “impaired parasympathetic nervous system, the part of the nervous system responsible for helping the body calm down.” Most of the time, researchers say, this is brought on by emotional stress, whether it be anger, anxiety or physical stresses—which no gender or age group is immune to.

“It is a romantic notion, but you really can get this from heartache,” wrote Dr. Harmony Reynolds, lead author of the study.

Can You Die From A Broken Heart?

Technically, yes.

According to the AHA “broken heart syndrome can lead to severe, short-term heart muscle failure.”

Arrhythmias (irregular heartbeats) or cardiogenic shock–a condition in which a suddenly weakened heart can’t pump enough blood to meet the body’s needs–can also occur and it can be fatal if it isn’t treated right away. (Cardiogenic shock is the most common cause of death of those that have heart attacks.)

But dying from a broken heart is rare: the heart muscle is not permanently damaged and most people who experience it make a full recovery within weeks.

Even better news, if you’ve experienced it once, you’re at a low risk for it happening again, even if another event occurs. According to Johns Hopkins Medicine: “In the five years that we have been following patients with stress cardiomyopathy, none have experienced the syndrome a second time. Further, several of our patients went on to have other stressful events in their lives and none developed the syndrome again.”

Managing Stress to Heal a Broken Heart

With what we know about the impact of stress on the body (and the extreme stress that the ending of a relationship can cause), it’s only obvious that taking steps to reduce and better cope with stress in our daily lives is the first step in preventing and recovering from a bout of Broke Heart Syndrome.

“It is important to take care of an ongoing stressful lifestyle, because you are more susceptible to acute stresses if you are already under a lot of stress or if you consistently operate at a high level of stress,” said Shushansky. “Remember, there is no quick ‘fix’ for a sudden loss, or for any significant loss in your life. But if you take a step back from the event to take care of yourself in the ways that will be effective for you, you can reduce the amount of stress and anxiety the loss would otherwise produce.”

The following tactics will help manage daily stress levels, and reduce the acute symptoms associated with heartbreak, loss, and other emotionally charged events.

Adopt a healthy lifestyle. Taking steps to alleviate daily stress may set you up to better handle a break-up, divorce, death, or other extreme emotional stressor that has the potential to cause Broken Heart Syndrome. “There’s much written and believed about how a combination of a healthy diet, exercise, maintaining positive relationships, and stress-reducing activities can prevent a number of physical and mental disorders and help diminish acute stressful situations,” said Shushansky. “Be it yoga, meditation, solitude and contemplation, time set aside to relax and smell the roses, read, have regular enjoyable activities, practice random acts of kindness and gratitude, and other similar undertakings.”

Consider medicine. In serious cases or in particularly at-risk patients doctors will sometimes prescribe medication–like beta blockers, diuretics, aspirin and others–that are used to treat high blood pressure, blood clots and stress hormones, explained the National Heart Lunch and Blood Institute.

Allow yourself to grieve. Although it’s painful, the pain you feel from grieving will not physically harm you “if you allow yourself to be present enough to cry, be angry, talk about it, and feel whatever it is you’re feeling,” said Shushansky. “Let yourself know that grief is normal and be ‘okay’ with it: A man once came to see me who had just lost his son in a tragic accident and felt like he was going ‘crazy.’ He described the intense feelings and thoughts he was having and wanted to make sure he wasn’t ‘losing his mind.’ Once he realized that what he was going through was normal, he knew he would be okay.”

Meditate. Research recommends practicing breathing and relaxation techniques to help combat stress. Deep abdominal breathing, meditation, focusing on a soothing word (such as peace or calm), and visualizing tranquil scenes are all ways to calm your thinking and may have positive effects on reducing stress levels. “Be aware of your state of being; that is, be aware that you are becoming anxious, and try to divert your thoughts to something other than the precipitating event,” said Shushansky.

Avoid alcohol and drugs. “While these may seem to give you some relief, they are depressants and physiologically will make it harder to think clearly and physically feel better,” said Shushansky. “Alcohol and drugs will ultimately add to your stress as opposed to reduce it.”

Do yoga: Moving the body with any form of exercise helps deepen breathing, but movement therapies like yoga and tai chi combine fluid movements that incorporate deep breathing and mental focus, which induces calm, said the AHA. Plus, yoga and meditation are proven to help alleviate the body’s fight-or-flight stress response and improve the parasympathetic nervous system.

Build your social network: “There may be a tendency to withdraw, but it’s healthier to stay connected to others,” said Shushansky. Buffering theory claims that people who have close relationships with others receive emotional support that helps to sustain them during times of stress and crisis. Social support from friends, co-workers, relatives, and spouses provide a safety net to fall back on when emotionally-charged situations arise. To manage the stress-induced acute symptoms associated with these situations, “try to be with someone you can talk with who can let you vent or help calm your thoughts,” said Shushansky.

This post was originally published on Everup.


Brianna Steinhilber is the wellness editor at Everup. Her diet motto is: Eat real food, not too much, mostly kale (thanks to Michael Pollan). 


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