The Science Behind Broken Heart Syndrome

It might feel like a heart attack, but broken heart syndrome is far from it.

When 62-year-old Joanie Simpson woke up with a serious backache and chest pain following the death of her beloved Yorkshire terrier, she assumed she was having a heart attack. Soon afterward, the Texas native was airlifted to a hospital in Houston, where a cardiologist administered a coronary angiogram, a special type of X-ray, to determine if her arteries were blocked. Simpson’s results came back clean.

But after further testing, a different diagnosis emerged. Doctors told Simpson she had takotsubo cardiomyopathy, also known as broken heart syndrome. She acknowledged that the death of her dog caused her extreme distress, which may have triggered the illness.

Simpson was released from the hospital after two days, and a year later, didn’t have any further symptoms. But how did emotional stress cause her broken heart?

Understanding stress?
Stress is the body’s reaction to a challenge or demand placed on it. It’s a broad definition, and just about anything can be a stressor, including a job loss, a car accident or the death of a loved one.

When you experience stress, the body releases a number of hormones that make your muscles tense up, your heart beat faster and your lungs take in more oxygen. That’s good when you have to fight off or escape from danger, but operating your body in a constant red-alert state can cause serious health problems.

Acute stress is stress that disappears quickly. A crying baby can stress you out, but the stress goes away when the baby quiets down. Chronic stress, like that experienced during a long-term illness or unhappy marriage, doesn’t go away so easily. Chronic stress can cause anxiety, hypertension, insomnia, a weakened immune system and a host of other problems, which can increase your risk for heart troubles.

Can stress cause a heart attack?
In addition to raising heart disease risk factors, stress can directly cause more serious heart problems. One large 2014 study published in JAMA Internal Medicine found that the risk of stroke and heart attack for older adults was more than doubled in the 30 days after a spouse’s death.

A separate 2013 study published in Stroke found that people with the highest chronic stress scores were 59 percent more likely to have a stroke or transient ischemic attack (TIA) than the people with the lowest stress scores. Additionally, the most depressed people were 89 percent more likely to have a stroke or TIA than the least depressed, and the most hostile were more than twice as likely to have a stroke or TIA than those with the least hostility.

Stress and broken heart syndrome
Severe emotional or physical stress can also cause broken heart syndrome, a temporary condition that mimics symptoms of a heart attack, such as chest pain and shortness of breath. Broken heart syndrome (also known as stress cardiomyopathy or takotsubo cardiomyopathy) is typically temporary and most people recover fully, though a 2015 study in The New England Journal of Medicine found that 7 percent of people with broken heart syndrome experienced serious complications such as stroke. Unlike with a heart attack, tests will show no or very little signs of damage to the heart, nor will they show a clot blocking coronary arteries. An electrocardiogram (EKG) of a stress cardiomyopathy will look different than an EKG of a heart attack.

Your best defense against stress
One of the best ways to relieve stress and help your heart at the same time is exercise. Not only does it improve your physical condition, it can reduce stress hormones and releases endorphins, the body’s natural painkillers and mood elevators. Experts recommend at least 150 minutes per week of moderate-intensity exercise or 75 minutes per week of vigorous-intensity exercise.

Find out how stress might be aging you by taking the RealAge test, which measures how your health habits and behaviors, like proper stress management, affect your longevity.

Medically reviewed in July 2021.


Harvard Health Publishing. “Takotsubo cardiomyopathy (broken heart syndrome).” January 29, 2020. Accessed July 12, 2021. “Why You Can Literally Die of a Broken Heart.” October 21, 2017. Accessed June 4, 2021. “A Woman Has Suffered a Clinical Broken Heart After the Death of Her Dog.” October 21, 2017. Accessed June 4, 2021.
A Maiti, A Dhoble. “Takotsubo Cardiomyopathy.” The New England Journal of Medicine. October 19, 2017.
MedlinePlus. “Stress and your health.” May 25, 2021. Accessed June 4, 2021.
American Psychological Association. “Stress effects on the body.” November 1, 2018. Accessed June 4, 2021.
American Psychological Association. “Stress won’t go away? Maybe you are suffering from chronic stress.” October 25,2019. Accessed June 4, 2021.
Johns Hopkins Medicine. “Broken Heart Syndrome.” 2021. Accessed June 4, 2021.
C Temmplin, J Ghadri, et al. “Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy.” The New England Journal of Medicine. September 3, 2015. “Is Broken Heart Syndrome Real?” 2021. Accessed June 4, 2021. “Stress and Heart Health.” June 17, 2014. Accessed June 4, 2021.
S Everson-Rose, N Roetker, et al. “Chronic Stress, Depressive Symptoms, Anger, Hostility and Risk of Stroke and Transient Ischemic Attack in the MESA Study.” Journal of the American Heart Association. July, 10, 2014.
I Carey, S Shah, et al. “Increased Risk of Acute Cardiovascular Events After Partner Bereavement: A Matched Cohort Study.” JAMA Intern Med. 2014. “Exercise can reduce stroke risk.” July 18, 2013. Accessed June 4, 2021.
Harvard Health Publishing. “Exercising to relax.” July 7, 2020. Accessed June 4, 2021.

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