Cause of death: Broken heart (it’s an actual syndrome, and can kill you)

We’ve probably all heard of a story like this. One half of a long-term married couple dies. Shortly thereafter, the spouse, who was apparently healthy, is found dead. Family and friends are shocked. Some say the surviving spouse just couldn’t live without their partner of 50+ years. And they might just be right. I’m here to tell you that you can quite literally die of a broken heart.

The syndrome was first discovered in Japan in the 1990s. Some cardiologists reported finding five patients who presented with symptoms very much like heart attacks: chest pain, shortness of breath and other physical symptoms. Most had EKG changes suggesting that they had a heart attack. But the biochemical tests that can indicate a heart attack, instead of being significantly elevated as they often are in cases of heart attack, were only increased a little above normal.

Broken heart by Shutterstock

Broken heart by Shutterstock

When the cardiologists did coronary angiograms (similar to a cardiac catheterization), injecting dye into their coronary arteries, these patients had normal coronary arteries – no excessive plaque causing blockages. So no evidence on a heart attack on imaging either.

The doctors went further and injected dye into the atria and ventricles of the heart. This time there was an abnormality and a major one (look at the photos below to see what the ventricle should look like, as compared to the video):

Compare the video with this:

A is ventricle bulging in takotsubo, B is a normal ventricle.

A is ventricle bulging in takotsubo, B is a normal ventricle. Credit: Zorkun

The left ventricle (the major pumping chamber of the heart) was bulging abnormally, and not contracting as strongly as it should. In some cases it was only pumping out about 1/3 of the blood that it should be ejecting from the heart.

Some of these patients needed external cardiac support for brief periods because of this inefficient pumping. Because the characteristic bulging of the ventricle resembled the fishing pot that is used in Japan to trap octopi, this cardiomyopathy (heart muscle disease) was named tako-tsubo (octopus pot) cardiomyopathy.

takotsubo-pot-ans-ventriculogram

B is the octopus pot, A is the left ventricle bulging in takitsubo. Credit: Wikidoc.org

Interestingly, most cases (~85%) of takotsubo cardiomyopathy occur in women, often older women from post-menopause age upwards. Though much younger patients of both sexes have developed it. It can be severe enough to cause death from shock or other causes. But if recognized early, and treated appropriately, patients survive and the ability of their ventricles to pump normally usually returns over a period of several days.

At first, it was thought that takotsubo was quite rare and might be limited to just Japan. But since the initial report, many more cases have been found in several countries in Europe, the United States, South America and elsewhere.

Takotsubo cardiomyopathy can be triggered by several things: e.g., a severe emotional/psychological shock (death of a family member, financial ruin, being in intensive care, etc.), or physical trauma (like choking). But in about one-third of the cases, there is no known emotional or physical trauma that precipitates it. The mechanism of how it happens may have to do with spasm of the coronary arteries. Or perhaps, the very tiny vessels in the heart muscle are part of the problem. It may be due, in part, to the arterial supply to the left ventricle or other causes or a combination of the above.

Initially, since the first patients were all women who were post-menopausal, it was thought that it was due to decreased estrogen in women in that age group. But as younger women and men developed it, this theory was discarded.

So the cause and mechanism are unclear. But it is indeed a syndrome that causes a broken heart, and one that can be deadly.


Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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13 Responses to “Cause of death: Broken heart (it’s an actual syndrome, and can kill you)”

  1. karmanot says:

    After the death of my first love, it took six years before I could feel anything again. In that kind of grief we die too, but long down the line we become wise and live again. For me life is even more precious.

  2. arleeda says:

    That’s what everyone says to me about my husband’s death, and I know it is true. But it would have been better for us to go together.

  3. arleeda says:

    My husband died three months ago age 71. I would prefer not to go on, but I guess I must. I don’t believe in an afterlife, and what has been described as heaven is nothing I would really want. All most of us want is for this life not to end!

  4. BeccaM says:

    (((hugs))) If there’s anything like an afterlife, I’m sure he knows.

  5. Mike_in_the_Tundra says:

    I think it would be easy to do. I knew I would never have another relationship like the one with my husband. It really felt like we were two parts of one whole. I really wanted to die, but we did have the two children. It was obvious they expected me to stick around. There have been two grandchildren since then. He never knew.

  6. Whitewitch says:

    Ditto…although it would be nice not to have to wash any dirty undies for a week or two before I followed.

  7. karmanot says:

    Same here

  8. Monoceros Forth says:

    “You know, Jasper, they may say she died of a burst ventricle, but I know she died of a broken heart.” Sorry, that’s bad, but it’s the first thing that came to mind.

  9. BeccaM says:

    It wouldn’t surprise me at all if I died not long after my wife passed.

    I don’t think I’d mind or care, either.

  10. emjayay says:

    We always talk about affairs of the heart and give heart shaped chocolate at Valentines’s day and all that, which probably dates back many centuries to when people had no idea what really goes on inside their bodies, including blood circulation and their brains and anything else. Now it turns out that there’s something to it.
    I’m guessing a lot of people have experience of some kind of physical problems that seem to be atributable to loss, and know family stories about people seeminlg to die of a broken heart. I do.

  11. FLL says:

    Alexander the Great, at the age of 33 and seemingly healthy, died about six months after his life partner, Hephaistion, died.

  12. keirmeister says:

    I totally believe this happens.

    My in-laws have been married for a long time. The mother is definitely the stronger one. We often say that if one of them dies, it’s best that the husband goes first; because if the wife dies first, the husband will follow her within a week.

  13. Mike_in_the_Tundra says:

    I definitely believe one can die of a broken heart. I didn’t die when I lost my husband, but the loss caused terrible physical pain along with the emotional anguish. I developed breathing difficulties and depression. The doctor got me through it with medication and pointed me toward a grief support group.

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