Broken Heart Syndrome: One Nurse’s Journey to the Diagnosis

• A registered nurse with nearly 50 years of experience was diagnosed with Broken Heart Syndrome last holiday season.  
• Broken Heart Syndrome is a form of stress cardiomyopathy that occurs when the heart muscle becomes stunned or weakened. 
• Signs and symptoms of Broken Heart Syndrome include sudden severe onset of chest pain and shortness of breath, diaphoresis, irregular heartbeats, hypotension, heart palpitations, and feeling faint.

First, let me state that I have been an RN for over 48 years, mainly in the Emergency Department. I do not have a specialty in cardiology, only that I suffered my first myocardial infarction while on duty in the ED, experiencing chest pain in the anterior chest and feeling very tired. Fatigue, I was told, is the number one complaint of women when they are experiencing a heart attack along with chest pain. Talk about being in the right place at the right time!

Luckily for me, I was admitted immediately and sent for a cardiac catheterization early the next day. I was informed that my left anterior descending artery (LAD), or the widow maker as it is more commonly called, was about 90% to 95% occluded and that I would need a stent. That was in 2014, almost 10 years ago.

This past Christmas Eve, I experienced severe chest pain in the anterior portion of my chest. The pain felt just like it did a decade ago. Rushing to the hospital and after an EKG in triage, I was told I had had another myocardial infarction, as there were changes in my electrocardiogram and elevated troponin levels, which is a protein found in the cells in your heart muscles. Elevated troponin levels show that the heart muscle has sustained damage. As per the cardiologist on call, the timing was unbelievably bad, as the catheterization lab was closed the next day — Christmas Day.

The thought ran through my mind: was there ever a suitable time for a heart attack? I did not need a stent this time, which was good news, and my previous stent appeared to be open and working fine. The cardiologist who performed the cardiac catheterization came out to talk to me and tell me what he found. I was just a little loopy from my pre-procedure cocktail. The condition was something that, in all my years of nursing, I had never heard of!  

Characteristics of Broken Heart Syndrome

I had a condition called Takotsubo Syndrome, or as it is better known, Broken Heart Syndrome. It’s a form of stress cardiomyopathy that occurs when the heart muscle becomes stunned or weakened. You might feel as if you’re having a heart attack with chest pain and shortness of breath.

In Takotsubo, the heart arteries are not blocked. However, blood flow in the heart arteries might be reduced. It is an acute reversible form of left ventricular dysfunction precipitated by an emotional or physical stress event. As the cardiologist explained to me, it can be brought on by the death of a loved one, a severe accident, an unexpected loss, or the physical exertion of a sudden debilitating illness. 

Signs and Symptoms

The signs and symptoms of this syndrome include sudden, severe onset of chest pain and shortness of breath, diaphoresis, irregular heartbeats, hypotension, heart palpitations, and feeling faint. It’s temporary, and develops in response to an intense emotional or physical experience, which is why it’s also called Broken Heart Syndrome or stress cardiomyopathy. Everyone kept asking me if there was a recent death in my family!

The heart’s main pumping chamber changes shape, affecting its ability to pump blood effectively. The heart looks like an octopus, with tentacles hanging down. The term Takotsubo is a Japanese term for an octopus trap. The shape seems, eerily, like the systolic ballooning of the left ventricle. It can occur at any age in males and females, mostly in older females. The cardiologist showed me a slide of what a Takotsubo heart looked like, and yes, it looked like an octopus or a jellyfish moving around. 

Treatment and Recovery

Treatment includes medications such as beta-blockers or ace inhibitors, which will aid in decreasing the stress on the heart and help the heart muscle recover. It’s described as a self-limiting condition, but can return later on. The heart muscle usually heals within two to four weeks. Most people affected by this syndrome fully recover within two to three months. I do remember feeling short of breath going up and down stairs. I thought I was imagining it, but my ejection fraction (EF) was at 30%, which was low. As I was informed, the normal EF should be more than 50%. The heart cannot pump sufficient blood to meet the body’s requirement with a low EF, which can lead to congestive heart failure.

It was then I was placed on Entresto to prevent heart failure and was told I had experienced a Type 2 heart attack upon my discharge from the hospital a few days later. No stent was placed, but I needed to follow up with cardiology in one to two weeks for a repeat EKG and echocardiogram, with a repeat cardiac catheterization in one year.  

The Bottom Line

Throughout this journey, I have to say that even though I have been a registered nurse working in the Emergency Department for many years and thought I had encountered almost every disorder, there are always new things to learn. Different people experience disorders; some may be well-known, and others may be discreet, such as Broken Heart Syndrome. 

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