Stress-Induced Cardiomyopathy

Also known as Takotsubo cardiomyopathy, stress-induced cardiomyopathy is a temporary heart condition characterized by a sudden weakening of the heart’s muscular function. More specifically, the left ventricle momentarily loses its ability to pump effectively, triggering heart attack-like symptoms, such as chest pain and shortness of breath. Unlike a heart attack, though, there is no blockage in the coronary arteries. Instead, experts believe a surge of stress hormones briefly disrupts the heart's normal function. Most cases of stress-induced cardiomyopathy are reversible, and the heart typically recovers over time with appropriate medical care.

For reasons that are not entirely clear, stress-induced cardiomyopathy occurs more frequently in women—particularly postmenopausal women—than men. Therefore, it is important to seek specialized care. The experienced cardiac specialists in the Women’s Heart Program at Tampa General Hospital’s Heart and Vascular Institute focus their practice on preventing, diagnosing and treating female-pattern cardiac conditions, including stress-induced cardiomyopathy.

What Causes Stress-Induced Cardiomyopathy?

Because stress cardiomyopathy is usually precipitated by severe emotional or physical stress, such as extreme grief, intense anxiety or sudden shock, it is sometimes referred to as “broken heart syndrome.” The resulting rush of stress hormones temporarily reduces the heart’s ability to pump effectively. The underlying mechanisms can include:

  • Stress hormone overload – High levels of adrenaline and other stress hormones can constrict blood vessels and reduce the flow of blood to the heart muscle.
  • Coronary artery spasms – As the coronary arteries forcefully contract, blood flow to the heart is reduced.
  • Microvascular dysfunction – Dysfunction in the smaller blood vessels within the heart may affect blood flow.
  • Inflammation – Inflammatory responses or changes in the heart muscle may also contribute to stress cardiomyopathy.

While severe emotional or physical stress is often the trigger of stress-induced cardiomyopathy, the condition can also occur in response to certain medical procedures, medications and health conditions.

What Are the Symptoms of Stress-Induced Cardiomyopathy?

The hallmark signs of stress cardiomyopathy can be very similar to those of a heart attack, including:

  • Intense pain or crushing pressure in the chest
  • Breathlessness
  • Weakness, lightheadedness or unusual fatigue
  • Irregular heartbeat
  • Nausea and vomiting
  • Profuse sweating (diaphoresis)

How Is Stress-Induced Cardiomyopathy Diagnosed?

Because the symptoms of stress-induced cardiomyopathy can also be caused by a life-threatening cardiac condition, it is imperative to seek emergency medical attention. A physician can perform appropriate testing to rule out a heart attack and confirm the diagnosis. The diagnostic process may include:

  • A clinical assessment – A physician will take a detailed medical history, including any recent emotional or physical stressors, and perform a physical examination.
  • An electrocardiogram (EKG) – An EKG records the heart’s electrical activity and can reveal abnormalities in heart rhythms or patterns that may suggest a heart attack.
  • Blood work – Cardiac biomarkers, such as troponin, may indicate heart muscle damage.
  • A coronary angiography – X-ray images taken with contrast dye can help a physician visualize any blockages or abnormalities in the coronary arteries.
  • An echocardiogram – An ultrasound test that provides real-time images of the heart, an echocardiogram can show characteristic changes in the heart’s shape and function caused by stress-induced cardiomyopathy.
  • Cardiac magnetic resonance imaging (MRI) – Detailed images of the heart can help a physician confirm the diagnosis and assess the extent of heart muscle involvement.
  • Radionuclide imaging – Images taken after a small amount of radioactive material is injected into the bloodstream can help a physician evaluate the flow of blood to the heart.

Often, stress-induced cardiomyopathy is considered after other causes are ruled out and diagnostic images show telltale changes in the shape and function of the heart. For instance, apical ballooning cardiomyopathy is a subtype of stress-induced cardiomyopathy in which the left ventricle’s apical region balloons outward when the heart muscle contracts and pumps blood into the arteries. An early and accurate diagnosis of stress-induced cardiomyopathy is crucial because it will allow for appropriate medical intervention and management.

Stress-Induced Cardiomyopathy Treatment

The goals of treating stress-induced cardiomyopathy are to manage the symptoms, prevent complications and provide emotional support. Some key aspects of treatment include:

  • Stress management – Given the relationship between emotional and physical stress and the onset of stress-induced cardiomyopathy, a physician may suggest stress management strategies, such as lifestyle modifications and relaxation techniques, to reduce the risk of a recurrence.
  • Medications – A physician may prescribe pain relievers for chest discomfort, anti-anxiety drugs for stress and/or treatments for heart failure symptoms, such as shortness of breath.
  • Monitoring – Most patients are monitored with repeat echocardiograms, cardiac MRIs and other tests to track their heart function as they recover.
  • Supportive care – Because stress-induced cardiomyopathy is often triggered by emotional or physical stress, many patients benefit from counseling and support groups to help them cope with the psychological aspects of the condition.

The prognosis for patients with stress-induced cardiomyopathy is generally good, and normal heart function is usually restored within a few weeks to a few months.

Benefit From World-Class Care at TGH

TGH is nationally recognized for providing advanced, superior care for patients with heart disease. The interdisciplinary team in our Women’s Heart Program includes many respected specialists who focus exclusively on preventing, diagnosing and treating cardiac issues that predominantly affect women, such as stress-induced cardiomyopathy. We are proud to be the only hospital in the Tampa Bay region to be included in the list of “100 Hospitals and Health Systems with Great Heart Programs” compiled by Becker’s Hospital Review.

If you would like to talk with an expert at TGH, contact us at (813) 844-3900 to request an appointment.