It begins like a heart attack. The chest tightens. Breathing becomes shallow. Fear creeps in. But when doctors examine the heart, they find no blocked arteries. Instead, the heart has changed shape—ballooned, stunned—struggling to pump blood. It’s not really a heart attack. It’s something else. And it can kill you.
In one of the largest studies of its kind, researchers have found that Takotsubo cardiomyopathy—more commonly known as broken heart syndrome—has a stubbornly high mortality rate. Drawing on data from nearly 200,000 U.S. adults hospitalized with Takotsubo between 2016 and 2020, the study reveals that 6.5% of patients died, a rate that held steady throughout the five years.
“The continued high death rate is alarming, suggesting that more research be done for better treatment and finding new therapeutic approaches to this condition,” said M. Reza Movahed, an interventional cardiologist at the University of Arizona’s Sarver Heart Center and lead author of the study.
A Stress Surge That Changes the Heart
Takotsubo cardiomyopathy was first recognized in Japan in 1990, named after a pot used to trap octopuses—its shape resembling the ballooning of the left ventricle seen in this syndrome. It often strikes after intense emotional or physical stress: the death of a loved one, a bitter divorce, even a car crash. The heart doesn’t just ache—it morphs.
Scientists suspect this shape-shifting is a reaction to a spike in stress hormones like adrenaline. The condition mimics a heart attack, presenting with chest pain, shortness of breath, and abnormal ECG readings. But when cardiologists look closer, they find a different story: arteries are clean, but the heart’s walls bulge and stiffen.
Although Takotsubo is often thought of as transient—patients usually recover—it’s anything but benign. The new study shows that patients with this condition faced double the risk of death compared to those hospitalized with other cardiac issues.
And that’s just the beginning.
Complications Are Common—and Deadly
Along with its high death rate, Takotsubo cardiomyopathy comes with a plethora of other complications:
- Congestive heart failure in 36% of cases
- Atrial fibrillation in over 20%
- Cardiogenic shock, a life-threatening drop in blood flow, in nearly 7%
- Strokes in more than 5%
- Cardiac arrest in 3.4%
Each of these events carries its own dangers.
“Takotsubo cardiomyopathy is a serious condition with a substantial risk of death and severe complications,” Movahed emphasized. “These patients should be monitored for serious complications and treated promptly.”
Despite these risks, outcomes did not improve between 2016 and 2020. In fact, mortality ticked up—from 5.63% in 2016 to 8.38% in 2020, even as awareness of the syndrome grew.
Twice the Death Rate
Most patients—83%—were women, especially post-menopausal. This fits the long-standing belief that broken heart syndrome predominantly strikes older women, possibly due to hormone shifts that make the heart more sensitive to stress.
But the new data tell a more nuanced story.
Men, though less frequently affected, are dying at more than twice the rate of women: 11.2% vs. 5.5%. And while women’s symptoms are often linked to emotional stress, men’s cases are more likely triggered by physical trauma—and more likely to be fatal.
One theory points to men’s stronger surges of stress hormones, like adrenaline, which could cause more damage. Another possibility is that men present later, or that doctors are less likely to suspect the syndrome in them, delaying treatment.
Age, Race, Inequality
Age matters, too. The study found a clear rise in incidence with age, especially in people over 61. But the most dramatic jump came between the age groups 31–45 and 46–60, with middle-aged adults 2.6 to 3.25 times more likely to develop the syndrome than their younger counterparts.
Race and income also played roles. White adults had the highest incidence of Takotsubo (0.16%), followed by Native Americans (0.13%) and Black adults (0.07%).
Hospital characteristics mattered as well. Urban teaching hospitals and large facilities saw more cases, perhaps due to better diagnostic tools or higher patient volumes.
Researchers noted a sharp rise in mortality from 2019 to 2020, coinciding with the COVID-19 pandemic. Previous studies suggest the virus, and the stress it caused—both physically and emotionally—could trigger Takotsubo cardiomyopathy. Patients with both COVID-19 and Takotsubo have been found to fare worse than those with the heart condition alone.
Stress, it turns out, is contagious.
Where We Go From Here
Despite being recognized for over three decades, Takotsubo cardiomyopathy remains shrouded in mystery. Its exact biological mechanisms are still unknown, and there is no standard treatment protocol. Doctors manage the symptoms—stabilize the heart, treat complications—but have no targeted therapy.
This new study drives home an urgent point: better care is needed, and soon.
“Clinicians need to improve care of these patients to reduce mortality and study the reason for sex differences in outcome,” the authors wrote.
The findings raise critical questions: Why has mortality not improved? What can be done to prevent complications? And why, after all these years, is a condition that mimics a heart attack still so often misdiagnosed?
For now, awareness is key. Recognizing that chest pain may stem not from a blocked artery, but from a grief-stricken or stress-ravaged heart, could mean the difference between life and death.
After all, heartbreak isn’t just a metaphor. Sometimes, it’s a medical emergency.
The findings appeared in the Journal of the American Heart Association.
