“Stress” cardiomyopathy: A different kind of heart attack

Deepak Bhatt, MD, MPH

Most heart attacks are due to coronary arteries being blocked by blood clots that form when plaques of cholesterol rupture. The lack of blood flow through the blocked arteries results in heart muscle dying — hence the name “heart attack.”

But over the past few years, physicians have come to recognize and better understand another form of heart attack. This unusual type of heart attack does not involve rupturing plaques or blocked blood vessels. It is called takotsubo cardiomyopathy, or stress cardiomyopathy. Japanese doctors, who were the first to describe this condition, named it “takotsubo” because during this disorder, the heart takes on a distinctive shape that resembles a Japanese pot used to trap an octopus. The disorder was commonly believed to be caused by sudden emotional stress, such as the death of a child, and to be far less harmful than a typical heart attack. For that reason, some had also labeled this condition “broken-heart syndrome.”

A study in the September 3 issue of The New England Journal of Medicine reports on the work of an international collaboration of physicians from the United States and Europe that studied 1,750 patients with takotsubo cardiomyopathy. Interestingly, 90% of these cases occurred in women, and the women in this study were an average of 67 years old. The most common triggers of stress cardiomyopathy were physical (such as lung problems or infections), and the next most common cause was an emotional “shock.” But in a substantial proportion of patients, there was no trigger that could be identified.

Compared with people who had experienced a “typical” heart attack, patients with takotsubo cardiomyopathy were almost twice as likely to have a neurological or psychiatric disorder. And in contrast to the commonly-held belief among doctors that takotsubo cardiomyopathy is less serious than other forms of heart attack, the rates of death in the hospital between takotsubo cardiomyopathy and more “traditional” heart attacks were similar.

As awareness of this disease increases among physicians and patients, I suspect we will be recognizing even more cases of takotsubo cardiomyopathy in the future. The condition certainly does not appear to be as rare as was suspected, nor as harmless as had been believed. Future research will be needed to determine the best care for patients with takotsubo cardiomyopathy and lower their risk for future problems. Right now, we often use the same medications to treat weakened heart muscle in takotsubo cardiomyopathy as we do with other forms of heart attack, but there really are not many good studies yet regarding the optimal medication choices for people who have experienced takotsubo cardiomyopathy. The link with neurological or psychiatric disorders is intriguing, and suggests that an important heart–mind connection is relevant to some manifestations of takotsubo cardiomyopathy, and possibly to other cardiac conditions as well. This paper in The New England Journal of Medicine will surely spawn greater interest in studying this fascinating disease.

Related Information: Harvard Heart Letter


  1. Nancy Hayes

    Could Stress Cardiomypathy effect your Ejection Fraction?

  2. Robin

    Thank you for your comment God is always there in troubled times including broken hearts. I have had the fear and symptoms you described and have also found myself in the E.R being checked. But without a doubt always was cleared medically and I know God has his time for me and nothing I do can stop that.
    God Bless

  3. Carlos Monteiro

    As I told recently in my article “Stress as Cause of Heart Attacks – The Myogenic Theory” (1,2), the etiology of Takotsubo cardiomyopathy is better explained by the myogenic theory of heart disease.
    According the Myogenic Theory heart disease is a three-stage process:
    Stage I: Stable angina, an intermittent and reversible process indicating regional myocardial ischemia (restriction in blood supply to the tissues) caused by physical exertion or psycho-emotional stress, and loss of regional myocardial contractility;
    Stage II: Unstable angina, a process that is still reversible, indicating regional myocardial insufficiency, which is episodic, spontaneous, and reversible, with regional myocardial ischemia;
    Stage III: Acute myocardial infarction (heart attack), an irreversible process characterized by regional myocardial insufficiency restrained and reversible only by cardiotonics; absolute regional myocardial ischemia; circulatory stagnation followed by myocardial necrosis; satellite coronary artery stasis, with possible fragmentation or displacement of atheromatous plaque due to the heart attack and vascular processes; and, on occasion, secondary coronary thrombosis.
    1) Stress as Cause of Heart Attacks – The Myogenic Theory first appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly journal of the Weston A. Price Foundation, Fall 2014
    2) Carlos Monteiro. Stress as Cause of Heart Attacks – The Myogenic Theory, originally published in the Wise Traditions Journal (Fall edition, 2014) from Weston A. Price Foundation. Reproduced in Positive Health Online (Issue 222, May 2015),

  4. Apple Pulmonology and sleep Centre

    thanks for sharing this post,it is more informative fr us!

  5. Linda Marzucco

    I don’t know if my comment went through I will start over here’s my story I got a bad phone call I mean it was bad I hung up here’s my story I got a bad phone call I mean it was bad I hung up immediately my bowels evacuated then I became very cold and sweaty and shaky my chest hurt to the extreme also my stomach. my head felt like it was going to blow off my ears were humming so loud like 4000 decibels I could hear my heart pounding so loud it was out of this world the nausea was so to the extreme that it actually hurt I couldn’t stand up I could not breathe it was so hard then I became very cold and sweaty and shaky mike just hurt to the stream also my stomach. My head felt like it was going to blow off my ears were home ing so loud like 4000 double I could hear my heart pounding so loud it was either this world the nadia was so to the extreme actually hurt I couldn’t stand up I could not read it was so hard actually breathe. I was unbalanced I laid on the floor I knew I was going to die I wrote a letter to God only about 5 words I could not take in food not even some sugar on a spoon I got through that night I could not sleep all night the pounding of my heart was so loud in my ears it was pure hell I got night I could not sleep all night the pounding on my heart was so loud in my ears it was pure hell I promise God if you don’t kill me I will go to the ER in the morning so then I had to get a shower because I looked really bad then I drove to the emergency room it was absolute hell drive prayed every second and distracted myself with singing they tested my heart it did not show damage they were very kind to me it really helped I can’t explain it I read so many of these articles about stress and I kept crying tonight this happened 7 months ago and I could never figure out what it was. so when I came upon these sites I am very relieved because I now know what happened. the next day it felt like someone shot me in the back with an elephant gun between my two shoulder blades my jaw side of my head bothered me with numbness and twitching it took about 2 weeks to stop all the weird symptoms I know for sure my brain was swelling my chloride levels crashed there was none no salt thank you for this site it truly was a broken heart I really did almost die you can die from being so so sad so hurt so crushed thank you God for saving my life amen