How Covid-19 Is Related to Broken Heart Syndrome
Covid-19-related stress and anxiety may raise broken heart syndrome risk, which can mimic the symptoms of a heart attack.
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You’ve probably heard: Covid-19 packs one hell of a wallop. In addition to triggering severe respiratory illness in some people, Covid-19 may set off diabetes in otherwise healthy individuals, raise the risk of heart disease, and lead children to develop organ-damaging inflammation. And now, in a July 2020 study in JAMA Network Open, researchers at the Cleveland Clinic are reporting an increase in another condition that’s related to the stress of Covid-19: broken heart syndrome.
What is broken-heart syndrome?
A broken heart is fodder for love songs, romance novels, and many rom-coms. But, broken heart syndrome—it also goes by takotsubo cardiomyopathy or stress-induced cardiomyopathy—is a real physical ailment that occurs when a traumatic event causes your heart muscle to weaken. The event can be emotional, such as the sudden death of a loved one, divorce, or job loss; or it can involve physical stress, such as that brought on by illness or an asthma attack. Even a good shock such as winning the lottery can cause an episode of broken heart syndrome. Certain medications may also trigger symptoms of this syndrome including epinephrine, a drug used to treat severe allergic reactions or asthma attacks that can also cause an adrenalin rush.
Symptoms of broken heart syndrome may include:
These tend to occur very soon after the triggering event. Broken heart syndrome looks and feels like a heart attack. (More on how to tell the difference between the two later.)
The link between broken heart syndrome and Covid-19
In the new Cleveland Clinic study, researchers compared individuals diagnosed with broken heart syndrome during the pandemic (between March 1 and April 30) to those who were diagnosed with the condition at three other points in time prior to Covid-19. More people were diagnosed with broken heart syndrome during coronavirus than these other time periods—7.8 percent versus 1.7 percent, respectively.
None of the individuals who were diagnosed with broken-heart syndrome during the pandemic had Covid-19, suggesting that it is the mental stress contributing to the increase, not the virus.
What’s driving the rise in broken heart syndrome?
Individuals with the temporary heart condition during the pandemic stayed in hospitals longer compared with their counterparts who were diagnosed with the syndrome before Covid-19—eight days versus four or five, respectively. “Psycho-socio-economic stress from the pandemic has resulted in a rise in broken heart syndrome/stress cardiomyopathy,” says study author Ankur Kalra, MD, interventional cardiologist, Cleveland Clinic, Akron, Ohio.
Dr. Kalra designed the study after noting an uptick in the number of broken heart syndrome cases during the lockdown months in Northeast Ohio. His goal was to better understand if these were just a cluster, if they were related to coronavirus, or if they were a manifestation of stressors related to the pandemic. (Here are the ways to stay human during coronavirus.)
Grief and stress raise broken heart syndrome risk
This isn’t the first study to link broken heart syndrome to stressful national or international events. “After the Twin Towers on 9/11, several studies were published reporting increased heart problems,” says Redford Williams, MD, professor of psychiatry and behavioral sciences, Duke University Medical Center, Durham, North Carolina.
“The Covid-19 pandemic is an ongoing stressor (rather than the acute one with 9/11), and it is not surprising that it is contributing to the development of increased cardiac events known to be sensitive to stress,” he says. “The current paper suggests that a chronic stressor like the pandemic can be generating multiple incidents of broken heart syndrome.” (These are the heart-healthy tips cardiologists follow.)
The study was limited—it took place in two hospitals in Northeast Ohio—so it’s hard to extrapolate the findings to nationwide.
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Who’s at risk for broken heart syndrome?
Women are more likely to experience broken heart syndrome than men. In fact, it’s one of the five most common heart conditions in women. Most people with broken heart syndrome do not have any traditional risk factors for heart disease such as high blood pressure, diabetes, or obesity. While this condition can cause short-term heart muscle failure, it’s rare to die from broken heart syndrome. Typically, the condition is treatable and a full recovery can happen within weeks—plus, there’s a relatively low risk of reoccurrence, according to the American Heart Association.
Broken heart syndrome versus a heart attack
“It looks and feels like a heart attack,” says Nathaniel Smilowitz, MD, interventional cardiologist and assistant professor of medicine, NYU Langone Health, New York City. Unlike a heart attack, however, the heart muscle for the most part recovers from the insult, he says. Exactly what causes broken heart syndrome is not fully understood, but researchers think that certain hormones released during stress may temporarily impede your heart’s ability to pump blood throughout the body.
Broken heart syndrome is diagnosed largely by ruling out a heart attack. Your doctor may order an EKG (electrocardiogram) to measure your heart’s electrical activity, as well as other heart imaging tests. There will also be a physical exam and blood testing for substances released into the blood when the heart is damaged or stressed. With broken heart syndrome, the results are higher than normal but not as high as expected with a heart attack.
“It is impossible to distinguish broken heart syndrome from a heart attack at home,” says Dr. Smilowitz. “If you have emotional stressors and develop these symptoms, see a doctor. This is not a benign condition. Medications and close monitoring can help treat some of the symptoms associated with broken heart syndrome,” he says.
How to lower your risk of broken heart syndrome
While some stress is inevitable, especially during the pandemic, you can take steps to change how you cope with it that are beneficial to your health, says Dr. Kalra. Self-care is the key, he says. He recommends training your body through exercise, tend to your mind with meditation or breathing and relaxation techniques, and enrich your spiritual life.
Dr. Smilowitz agrees. Find something that helps you relax and do it every single day. It can be as simple as deep breathing, taking a walk or listening to music, he says. “If you have a history of depression or anxiety or are feeling overwhelmed, talk to your doctor or a therapist.” (Here are some helpful tips to cope with depression during coronavirus.)
Cognitive behavioral therapy—a time-limited course of therapy that trains you to change how you react to stress—can also be effective, Dr. Williams adds. (Next: Here’s how to find an online therapist or counselor.)
- New England Journal of Medicine: "New-Onset Diabetes in Covid-19"
- American Heart Association: "Is Broken Heart Syndrome Real"
- Nathaniel Smilowitz, MD, interventional cardiologist and assistant professor of medicine, NYU Langone Health, New York City
- JAMA Network Open: "Incidence of Stress Cardiomyopathy During the Coronavirus Disease 2019 Pandemic"
- Aknur Kalra, MD, interventional cardiologist, Cleveland Clinic, Akron, Ohio
- Redford Williams, MD, Professor, Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina