Passing quietly away from sheer heartbreak is a trope that pops up in myth and fantasy. In the Star Wars universe, Padmé Amidala may have died of a broken heart after her husband turned to the dark side, becoming Darth Vader, and she gave birth to Luke and Leia. Shakespeare’s King Lear succumbs to heartbreak after hearing of the demise of his precious Cordelia.
Drama aside, it’s possible these characters fell to takotsubo syndrome — a short, intense dysfunction in the heart’s left ventricle. It can occur after extreme emotional or physical stress, making “heartbreak” both real and potentially deadly.
While dying of heartbreak has been a popular theme in fiction for a long time, clinicians only began documenting real cases in the 1960s, says Trisha Singh, a cardiologist at University Hospitals Dorset in England. “It was very typically described as an elderly or a middle-aged woman who just lost a loved one, and a day or so afterwards, she died of heartbreak.”
As imaging technology improved, doctors could directly study the hearts of afflicted patients. In many, the left ventricle — the chamber that pumps oxygenated blood to the body — balloons out. The shape reminded Japanese clinicians of a takotsubo, a round jar for catching lobsters and octopuses. In 1990, cardiologist Hikaru Sato and colleagues at Hiroshima City Hospital proposed the term takotsubo to describe the condition.
What triggers it is still something of a mystery. One hypothesis is that an acute traumatic event causes a surge of stress hormones such as norepinephrine in the brain and epinephrine in the adrenal glands. Because the left ventricle is especially rich in receptors for these chemicals, a sudden flood could cause the taut, elastic muscle to become loose and puffy, making it incapable of delivering enough blood to the body. Another hypothesis is that a stress response “stuns” the heart temporarily. With the majority of cases observed in postmenopausal women, it’s also possible that reduced estrogen plays a role.
Takotsubo syndrome is relatively rare, accounting for only about 2 percent of people who seek medical care for an apparent heart attack. Cardiologist Peter Rahko of the University of Wisconsin–Madison recalls a case from the 1980s. An older woman was called to a hospital in rural Wisconsin and shown the body of her son, who had died in a car accident. “Within five minutes, she started having severe chest pain [and] collapsed on the floor,” Rahko says.
The woman was flown to Madison, where Rahko snaked a catheter into her heart to see if a blockage was causing a heart attack. To his surprise, “her arteries were totally normal, but her heart function was dramatically reduced.” In takotsubo syndrome, the heart vessels are often clear. In fact, most patients do not have classic risk factors for heart problems.
In retrospect, Rahko now realizes his patient had takotsubo syndrome. Today, reduced heart function with no clear signs of disease is a tip-off. A doctor will look for acute stress, such as recent bereavement. In some cases, the tragic event is obvious. But even events with a more long-term effect like the COVID-19 pandemic or earthquakes in New Zealand have been documented as tipping points. Many patients, Singh notes, have mental illnesses such as anxiety or depression.
Though severe, takotsubo is remarkably short-lived and typically not fatal. About 4 percent of sufferers die, while about 75 percent fully recover after 10 days, as Rahko’s patient did. Many recover after only 48 to 72 hours. “It’s absolutely incredible,” Singh says. “I remember seeing a lady who’d come in, and her left ventricular function was severely impaired, and I came back and rescanned her six hours later, and it had gone from severely impaired to almost mildly impaired to almost normal.”
Standard care is to treat the patient for heart failure. “But now, more recently, especially with seeing some people recover so rapidly, it raises a question,” Rhako says. “Should we even be bothering with trying to put people on these medications? Are they even going to do any good?” It’s possible that with basic medical support for the patient, the heart may unbreak itself.
Knowing that takotsubo syndrome happens today, Rahko says, it wouldn’t surprise him if some deaths from “grief” in history were takotsubo. When people had little but belief to go on, it was reasonable to think that “some god struck down somebody for whatever malfeasance there was and they dropped dead,” he says. Now “here’s one potential physiologic explanation.”