2006 Heart-Brain summit proceedings

The broken heart syndrome

ILAN S. WITTSTEIN, MD

Division of Cardiology,
Johns Hopkins University School of Medicine
Baltimore, MD

iwittste@jhmi.edu

ARTICLE INTRODUCTION

Throughout history, mankind has had an intuitive understanding of the connection between emotional stress and the heart. Descriptions of “heartache” and “dying from a broken heart”
have appeared in the literary works of diverse cultures for centuries. Similarly, the medical literature is replete with descriptions of sudden death and myocardial infarction (MI) in the setting of fear, anxiety, and bereavement. In the modern era, reports of sudden death and MI have been well documented in populations subjected to emotionally traumatic events such as natural disasters
and acts of war, but the direct effect of acute emotional stress on cardiac contractile function has remained obscure.

Recently, a novel syndrome of transient left ventricular (LV) systolic dysfunction precipitated by acute emotional or physical stress has appeared in the medical literature. For years this syndrome has been under-recognized and misdiagnosed, and only now are physicians beginning to appreciate the constellation of clinical features that characterize it.

This brief review will highlight those distinguishing features, provide some historical background
of this relatively new syndrome, and review what is known about its possible pathophysiologic mechanisms.

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