When heartbreak strikes, it can do more than shatter your spirit—it can literally shock your heart. A rare but serious condition called takotsubo cardiomyopathy, or “broken heart syndrome,” mimics the symptoms of a heart attack and often follows emotional or physical trauma. While many recover, a new study reveals that men may be at far greater risk of dying than women.
Triggered by extreme stress, be it emotional, like a breakup or grief, or physical, like an illness or injury, this temporary form of heart dysfunction stuns the heart muscle, often leading to chest pain and shortness of breath. What may appear to be a typical cardiac event is actually something more mysterious.
Though many people recover quickly from this temporary form of heart dysfunction, not everyone fares the same. According to a new study published Wednesday in the Journal of the American Heart Association, men are less likely to develop the syndrome but more than twice as likely to die from it compared to women.
Researchers examined hospitalization data from nearly 200,000 U.S. adults diagnosed with broken heart syndrome between 2016 and 2020. While the mortality rate for women hovered around 5%, it was significantly higher for men at roughly 11%.
“It seems to be a consistent finding that men don’t get takotsubo syndrome as much, but when they do, they do worse,” said Dr. Harmony Reynolds, director of the Sarah Ross Soter Center for Women’s Cardiovascular Research at NYU Langone Health. Reynolds was not involved in the research but noted its alignment with past findings.
Cardiologists suggest that part of the gender disparity may stem from the type of stressors that trigger the condition. Women typically experience it after intense emotional events, like the loss of a job or a romantic breakup, while men are more often affected following physical trauma such as surgery or a stroke.
Experts believe the condition may stem from a “surge of stress hormones, such as adrenaline,” which results in the “temporary squeezing of the large or small arteries of the heart,” affecting its ability to pump.
“The people with emotional stressors actually do quite well,” said Dr. Ilan Wittstein, a cardiologist at Johns Hopkins Medicine who was not part of the study.
“Men may be more at risk for dying and having bad outcomes because they’re less susceptible to begin with. So it takes a more dangerous trigger to precipitate the syndrome.”
Social dynamics might also play a role. The study’s lead author, Dr. Mohammad Movahed, a cardiologist at the University of Arizona’s Sarver Heart Center, told NBC News that men often lack strong emotional support systems, making recovery from stress more difficult.
“If you have this stressful trigger, and the stress is not gone, that’s probably going to continue to harm the heart, or at least reduce the chance of recovery.”
Despite years of research, much about broken heart syndrome remains unclear—including why it proves fatal in some cases and not in others. “People are still looking for the holy grail of what causes this condition,” Wittstein said.
During the five-year study period, various complications associated with the condition were observed. These included cardiogenic shock, affecting 6.6% of participants, where the heart fails to pump blood effectively. Additionally, 20.7% experienced atrial fibrillation, characterized by irregular heartbeats. Cardiac arrest was reported in 3.4% of cases, while congestive heart failure impacted 35.9%. Lastly, stroke occurred in 5.3% of individuals studied.
One thing cardiologists do understand is how to recognize it: patients often present with sudden chest pain or difficulty breathing. Tests may show a heart that balloons out in one section, resembling a Japanese octopus trap called a “takotsubo,” but without the arterial blockage typical of a heart attack. Most patients can also pinpoint a stressful event just before their symptoms began.
Dr. Matthew Tomey, a cardiologist at Mount Sinai Fuster Heart Hospital in New York City, put it simply: “The stresses that we endure in our daily lives, both physical and emotional, can, in fact, take tolls on us. You can feel the heartache in those moments, and there may literally be some heartache of sorts that’s accompanying that.”
But not every trigger is dramatic. Some patients have developed the condition after relatively mundane experiences, like getting stuck at a red light or vomiting from a stomach bug. “Some people just get a little frustrated at work, or somebody was out jogging a little too vigorously,” Wittstein said.
Reynolds recalled a patient who developed takotsubo syndrome four separate times—each episode sparked by mild gastroenteritis. “She just really hates vomiting and will throw up and get” the syndrome, Reynolds said.
Wittstein now theorizes that certain individuals may have a biological vulnerability, particularly those with high blood pressure or cholesterol. His research suggests stress hormones may constrict the heart’s small surrounding blood vessels, reducing blood flow and leading to cardiac dysfunction.
Reynolds said post-menopausal women also seem to be more at risk, possibly due to reduced levels of estrogen, which normally helps keep those vessels open.
“It’s at some level obvious that sex hormones are implicated. But trying to draw that link and really connect the dots, we have not gotten there yet.”
Treatment remains a challenge. While doctors may prescribe beta blockers or recommend stress-reducing therapies like meditation or counseling, there’s no proven protocol to prevent complications or death.
“We have not found anything so far—any medication, any specific treatment—that can reduce complications or reduce mortality,” Movahed said. His study found that fatality rates have remained relatively unchanged over the five-year period studied, suggesting the current approaches may not be enough.
“We were surprised to find that the death rate from Takotsubo cardiomyopathy was relatively high without significant changes over the five-year study, and the rate of in-hospital complications also was elevated. The continued high death rate is alarming, suggesting that more research be done for better treatment and finding new therapeutic approaches to this condition.”
Wittstein cautioned that interpreting those numbers isn’t straightforward. Because the study relied on hospital diagnostic codes, some patients might have died due to other conditions like strokes, even if they also had broken heart syndrome. “I’m quite sure that some of these people recovered from the broken heart syndrome and then died of complications of something else,” he noted.
For now, cardiologists emphasize that people experiencing chest pain or shortness of breath should seek immediate medical attention.
“You can’t tell the difference between this and traditional heart attacks until you get to the hospital and have a series of tests,” Reynolds said. “So it is not appropriate to stay home when you have chest pain.”
While broken heart syndrome may sound poetic, its risks are painfully real—and sometimes, the heart truly does bear the brunt of life’s most overwhelming moments.
Moumita Basuroychowdhury is a Contributing Reporter at The National Digest. After earning an economics degree at Cornell University, she moved to NYC to pursue her MFA in creative writing. She enjoys reporting on science, business and culture news. You can reach her at moumita.b@thenationaldigest.com.
