Pandemic-Related Stress Can Lead to Broken Heart Syndrome

The economic, physical and social stressors of the COVID-19 pandemic are causing an increase in stress-induced cardiomyopathy — also known as broken heart syndrome, report physicians around the country.

In the following Q&A, Marcus St. John, M.D., interventional cardiologist with Miami Cardiac & Vascular Institute, and medical director of the Cardiac Catheterization Lab at Baptist Hospital, shares his expertise on the subject and explains how stress can have physical effects on our bodies and our hearts.

What causes stress-induced cardiomyopathy?

Dr. St. John:
“Stress-induced cardiomyopathy is most classically caused by sudden severe emotional stress triggered by such events as the death of a loved one, a car accident, a natural disaster or, potentially, stressors related to the unprecedented pandemic we are currently experiencing. Other situations such as physical stress related to surgery can also be a precipitating factor. These life events are often difficult to predict or avoid, so recognizing symptoms is very important.”

What are the symptoms of stress-induced cardiomyopathy?

Dr. St. John:
“Usually, the initial diagnosis of stress-induced cardiomyopathy is the abrupt onset of symptoms that include shortness of breath and chest pain. These are often accompanied by elevations of heart enzymes and changes in the EKG that can mimic a heart attack.”

Should people with these symptoms call their doctor or go to the Emergency Department?

Dr. St. John:
“These patients should call 911 and/or go to the ER for an evaluation and initial stabilization. Commonly, they will undergo heart catheterization to exclude significant underlying coronary artery disease as the cause of their presentation.”

What is happening to the heart during this acute event?

Dr. St. John:
“Highly stressful events cause a release of stress hormones in the body that temporarily reduce the heart’s ability to pump efficiently and in a steady, normal pattern.”

Is this condition the same as or similar to a “panic attack?”

Dr. St. John:
“Absolutely not. Panic attack, though an important and debilitating condition, is not associated with severe heart dysfunction and is not usually life threatening. However, symptoms of extreme anxiety that may occur during a panic attack could, conceivably, result in stress cardiomyopathy.” 

Is every person with high stress at risk for stress-induced cardiomyopathy?

Dr. St. John:
“No. There is a more general impact of stress on the heart that may relate to an increased risk of palpitations, chest pain and high blood pressure. Additionally, stress hormones and the behavioral impacts of stress contribute to obesity, diabetes, smoking, alcohol consumption and other risk factors that can lead to cardiovascular disease. This type is stress-related heart disease is more commonplace than stress-induced cardiomyopathy.”

How can patients prevent or manage stress-related heart issues? 

Dr. St. John:
“For acute onset of stress-induced cardiomyopathy, recognizing the symptoms such as sudden onset of usually severe chest pain or shortness breath that does not quickly resolve and seeking emergency medical attention is the most important step in managing the condition. Preventive measures related more to the effects of chronic stress on the heart include reaching out to a healthcare provider and implementing healthy habits such as exercising, meditating, self-care and connecting with family and friends.” 

What is the treatment protocol for stress-induced cardiomyopathy?

Dr. St. John:
“Treatment for this condition is usual emergency care for sudden onset of chest pain and shortness of breath. These patients, initially, may be very sick and have fluid in the lungs, sometimes requiring mechanical ventilation and medication to support blood pressure. Once patients are through the acute phase, they are treated with medications that are generally prescribed for those with weak heart muscles of any cause (cardiomyopathy). It is important that these patients also treat and prevent risk factors for heart disease, such as high cholesterol, high blood pressure, sedentary lifestyle, smoking and more. And, of course, they should implement strategies to manage or reduce their stress. Patients are generally followed by their cardiologist to make sure the heart is stabilized.”

Is this condition temporary, or does it cause long-lasting heart issues or damage? 

Dr. St. John:
“The good news for patients with stress-induced cardiomyopathy is that it can often be a reversible cause of weakness to the heart muscle. For many patients, heart function can return to normal with time, proper lifestyle habits and medications for the heart.”