Broken heart syndrome (takotsubo): symptoms, causes, treatment and recovery

The BHF says people have told them takotsubo syndrome can feel a little like a heart attack. The NHS says the main symptoms are chest pain and breathlessness, similar to those of a heart attack, and says always call 999 if you or someone else experiences these.

• Sudden, intense chest pain.

• Pressure or heaviness on the chest.

• Shortness of breath.

• Less commonly: palpitations (a fluttering or pounding in the chest or neck).

• Less commonly: feeling faint or lightheaded.

• Less commonly: feeling or being sick.

The BHF explains that takotsubo syndrome causes the heart's main pumping chamber (the left ventricle) to change shape and get larger, so the heart muscle becomes weaker and its pumping action loses strength. "Takotsubo" comes from the name of a pot used in Japan to catch octopuses, which the left ventricle resembles. It is also called broken heart syndrome, stress cardiomyopathy or apical ballooning syndrome.

The NHS says the heart muscle becomes suddenly weakened or "stunned", and that it is temporary and reversible. Many people know it as broken heart syndrome because of its connection to grief, but the BHF stresses it happens when the body is coping with overwhelming physical or emotional stress. Unlike a heart attack, patients do not have a blockage of the arteries supplying the heart.

The BHF says no one knows the exact cause. Experts suggest that a rush of overwhelming stress hormones, such as cortisol and adrenaline, puts sudden stress on the heart, causing temporary damage. For some people an event like a death, illness, surgery, mental trauma or financial stress can trigger it. A 2024 BHF news piece says that around 30 per cent of people cannot identify a specific trigger.

The NHS gives bereavement and major surgery as examples of stress that can bring it on, and says it may be caused by a surge of hormones, particularly adrenaline. Takotsubo syndrome is more common in women, people over 50 and people with mental health conditions such as anxiety or depression.

The BHF says it is usually diagnosed after you come to hospital with heart attack symptoms. You will be sent for tests to see what the problem with your heart is, which may include blood tests, a coronary angiogram to see if there is a blockage in the heart's arteries, an ECG, an echocardiogram to see if the shape of the heart has changed, and an MRI scan.

You may be diagnosed with takotsubo syndrome if tests rule out a heart attack, your heart muscle looks weakened or is not pumping blood as it should, and your left ventricle has changed shape. The doctor may also ask about recent physical or emotional stress.

The BHF says there is not one treatment used for everyone. To manage symptoms and help your heart recover your doctor might give diuretics to reduce fluid build-up, beta blockers and ACE inhibitors or ARBs to take the pressure off your heart, and blood-thinning medicine if you are at high risk of blood clots or an arrhythmia such as atrial fibrillation.

To prevent another episode, many healthcare professionals recommend long-term treatment with beta blockers or similar medicines. The BHF is open about the limits of current knowledge: it says more research is needed, and a 2024 BHF-funded study of 3,720 people in Scotland found that standard heart attack medicines did not improve survival for people with takotsubo syndrome and that there is no expert consensus on how to treat it. Discuss your own plan with your cardiologist.

The BHF says the condition can last a few days or weeks and that, with medicine, most people recover completely. You might recover within a couple of months, once your body starts to cope better with any stress. People usually stay in hospital while they begin to recover and usually make a full recovery within weeks.

After diagnosis you will attend check-ups with a cardiologist, with echocardiograms to check how your heart is working. In rarer cases the heart might permanently change shape and symptoms might not completely go away. The BHF suggests getting active (it mentions yoga or a walk), eating healthily and talking to friends and family or support groups, and says talking to a counsellor or clinical psychologist may help, with NHS talking therapies available through a GP.

You cannot tell broken heart syndrome from a heart attack by symptoms alone. The BHF says if you think you are having a heart attack, call 999 immediately. The NHS says the same for chest pain and breathlessness. Do not wait to see whether it passes.

On the NHS, takotsubo syndrome is diagnosed and treated in hospital cardiology services after an emergency presentation, with follow-up in a cardiology clinic. Some people choose a private cardiology review for a second opinion or a follow-up echocardiogram, but the emergency care and diagnosis run through the NHS emergency pathway.