Nav: Home

Complication of broken heart syndrome associated with both short- and long-term risk of death

November 05, 2018

DALLAS, Nov. 5, 2018 -- When patients with broken heart syndrome survive a life-threatening complication that renders the heart suddenly unable to pump enough blood, they remain at greater risk of death for years afterwards, according to research to be presented in Chicago at the American Heart Association's Scientific Sessions 2018, a premier global exchange of the latest advances in cardiovascular science for researchers and clinicians. The study will also be simultaneously published in the American Heart Association's journal Circulation.

"Beyond the higher short-term mortality, for the first time this analysis found people who experienced broken heart syndrome complicated by cardiogenic shock were at high risk of death years later, underlining the importance of careful long-term follow-up especially in this patient group," said Christian Templin, M.D., Ph.D., lead author of the study and head of acute cardiac care at the University Heart Center at University Hospital Zurich, Switzerland.

Broken heart syndrome (also called takotsubo syndrome) is often triggered by physical or emotional stress in which the heart's main pumping chamber enlarges and does not pump well. Symptoms, such as chest pain and shortness of breath, mimic those of a heart attack, but there is no heart muscle damage or blockage in the heart's arteries, and recovery usually occurs in days or weeks, provided that the patient overcomes the acute phase, which can be life-threatening.

In about one in ten cases, patients with broken heart syndrome develop cardiogenic shock, a condition in which the heart suddenly cannot pump enough blood to meet the body's needs. Cardiogenic shock is a well-known cause of death after a severe heart attack, but prior to this study little was known about risk factors and outcomes when it occurs in patients with broken heart syndrome.

In the current analysis, researchers used the largest database on the syndrome, the International Takotsubo Registry, to compare 198 patients who developed cardiogenic shock (average age 63.4 years, 14.1 percent men) with 1,880 patients who did not (average age 67.2 years, 9.3 percent men).

The investigators found that, compared to broken heart syndrome patients without cardiogenic shock, those who experienced such complication were more likely to:
  • have had the syndrome triggered by physical stress such as surgery or an asthma attack (66.7 percent vs. 33 percent);

  • die while in the hospital (23.5 percent vs. 2.3 percent) and also significantly more likely to have died 5 years after the initial event;

  • have a common arrhythmia (atrial fibrillation), 13.1 percent vs. 5.7 percent, and/or less blood pumped out with each beat (lower ejection fraction), 32.7 percent vs. 41.6 percent, when admitted to the hospital;

  • have X-rays or ultrasound that show apical ballooning of the left ventricle (80.3 percent vs. 70.2 percent); and

  • have a history of heart disease risk factors such as diabetes (21.0 percent vs. 14.8 percent) or smoking (27.4 percent vs. 19.3 percent).

"The history and parameters that are easily detectable on admission to the hospital could be helpful to identify broken heart syndrome patients at higher risk of developing cardiogenic shock. For such patients, close monitoring could reveal initial signs of cardiogenic shock and allow prompt management," said Templin, who is also the deputy head of interventional cardiology at the Andreas Grüntzig Heart Catheterization Laboratories at the hospital.

The study also indicated that patients with cardiogenic shock were less likely to die during the initial episode if they were treated with cardiac mechanical support, such as an inflatable device that helps boost blood flow (12.8 percent vs. 28.3 percent).

"Although these devices should be used with caution, it could be considered as a bridge-to-recovery in patients without contraindications," Templin said.

Although the exact mechanism is not certain, broken heart syndrome is believed to occur in response to high levels of stress hormones following physical or emotional stress. Emotional stressors may be negative (such as the death of a loved-one) or positive (such as finding out you're a lottery winner). In about one-third of cases, the syndrome occurs without a known stressor.

Broken heart syndrome occurs most often in older women. Although the syndrome was first identified in Japan, the International Registry has documented cases from around the world.
The primary co-authors are Davide Di Vece, M.D., and Rodolfo Citro, M.D., Ph.D., who contributed equally to the paper. Other co-authors and author disclosures are on the manuscript.

The University of Zurich and the Zurich Heart House - Foundation of Cardiovascular Research funded the study.

Note: Scientific presentation is 12:55 p.m. CT, Saturday, Nov. 10, 2018.

Additional Resources: Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at

About the American Heart Association

The American Heart Association is a leading force for a world of longer, healthier lives. With nearly a century of lifesaving work, the Dallas-based association is dedicated to ensuring equitable health for all. We are a trustworthy source empowering people to improve their heart health, brain health and well-being. We collaborate with numerous organizations and millions of volunteers to fund innovative research, advocate for stronger public health policies, and share lifesaving resources and information. Connect with us on, Facebook, Twitter or by calling 1-800-AHA-USA1.

American Heart Association

Related Heart Attack Articles:

Muscle protein abundant in the heart plays key role in blood clotting during heart attack
A prevalent heart protein known as cardiac myosin, which is released into the body when a person suffers a heart attack, can cause blood to thicken or clot--worsening damage to heart tissue, a new study shows.
New target identified for repairing the heart after heart attack
An immune cell is shown for the first time to be involved in creating the scar that repairs the heart after damage.
Heart cells respond to heart attack and increase the chance of survival
The heart of humans and mice does not completely recover after a heart attack.
A simple method to improve heart-attack repair using stem cell-derived heart muscle cells
The heart cannot regenerate muscle after a heart attack, and this can lead to lethal heart failure.
Mount Sinai discovers placental stem cells that can regenerate heart after heart attack
Study identifies new stem cell type that can significantly improve cardiac function.
Fixing a broken heart: Exploring new ways to heal damage after a heart attack
The days immediately following a heart attack are critical for survivors' longevity and long-term healing of tissue.
Heart patch could limit muscle damage in heart attack aftermath
Guided by computer simulations, an international team of researchers has developed an adhesive patch that can provide support for damaged heart tissue, potentially reducing the stretching of heart muscle that's common after a heart attack.
How the heart sends an SOS signal to bone marrow cells after a heart attack
Exosomes are key to the SOS signal that the heart muscle sends out after a heart attack.
Heart attack patients taken directly to heart centers have better long-term survival
Heart attack patients taken directly to heart centers for lifesaving treatment have better long-term survival than those transferred from another hospital, reports a large observational study presented today at Acute Cardiovascular Care 2019, a European Society of Cardiology congress.
Among heart attack survivors, drug reduces chances of second heart attack or stroke
In a clinical trial involving 18,924 patients from 57 countries who had suffered a recent heart attack or threatened heart attack, researchers at the University of Colorado Anschutz Medical Campus and fellow scientists around the world have found that the cholesterol-lowering drug alirocumab reduced the chance of having additional heart problems or stroke.
More Heart Attack News and Heart Attack Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: Reinvention
Change is hard, but it's also an opportunity to discover and reimagine what you thought you knew. From our economy, to music, to even ourselves–this hour TED speakers explore the power of reinvention. Guests include OK Go lead singer Damian Kulash Jr., former college gymnastics coach Valorie Kondos Field, Stockton Mayor Michael Tubbs, and entrepreneur Nick Hanauer.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at