What Becomes of the Broken Hearted?

Dying of a broken heart sounds like something from a country song. But we’ve all heard the stories — the elderly couple married for decades that die within hours or days of the other’s passing. We often say that someone died of a broken heart. But is that really possible?

It turns out that a broken heart may be more than a metaphor. 

Broken Heart Syndrome

Sudden emotional stress — from grief, fear, anger or shock — can cause heart failure. The term for this is stress cardiomyopathy. It’s often called “broken heart syndrome,” and it mainly affects women.

Researchers at Johns Hopkins studied patients who had classic heart attack symptoms after a sudden emotional stress but were otherwise generally healthy with no history of heart disease.

The study found that these patients had consistently elevated blood levels of the stress hormones epinephrine, also called adrenaline, and norepinephrine, which appeared to cause a significant weakening of the heart muscle.

Scientists have known for decades that the body pours out adrenaline under stress in the "fight-or-flight" response. This response speeds the heart rate and tenses the muscles to get a person ready to fight or run from a threat. But for some, the rush of adrenaline may be more than the heart can take.

The resulting damage produces symptoms that mimic a typical heart attack, including chest pain, fluid in the lungs and shortness of breath. In fact, broken heart syndrome may be misdiagnosed as a heart attack because the symptoms and test results are similar. But unlike a heart attack, there are no signs of blocked heart arteries.

Instead, part of your heart temporarily enlarges and doesn’t pump well. The rest works as usual or with even more forceful contractions. It can lead to severe, short-term heart muscle failure. But it’s usually treatable, and most people make a full recovery. Why it affects some and not others is not clear.

The Connection Between Mental Health and Heart Health

We know the basic things that are key to protecting the heart. Control blood pressure and cholesterol levels. Manage diabetes. Eat healthy foods and keep a healthy weight. Limit or cut out alcohol. Don’t smoke.

But other factors affect your heart, too.

In addition to broken heart syndrome, studies show that mental health and cardiovascular health are linked in many ways, says the Centers for Disease Control and Prevention.

Some common mental health issues that can affect heart health include:

• Long-lasting stress
• Depression and anxiety
• Post-Traumatic Stress Disorder (PTSD)

These mental health conditions can have an indirect effect on heart health by increasing the likelihood of risky behaviors. They can also have a direct physical impact on the heart.

Stress, depression, anxiety and PTSD may cause higher heart rate and blood pressure, reduced blood flow to the heart, and high levels of cortisol, the body's stress hormone. Over time, these effects can lead to calcium buildup in the arteries and heart disease.

In turn, a cardiac event like a heart attack or stroke can cause mental health issues like depression, anxiety and PTSD.

If you have long-term stress, anxiety, depression or any mental health issue, talk to your doctor or other health care provider. It’s important to seek help for mental health issues and to follow the plan for managing them. Treatment and management of mental health conditions may include lifestyle changes, counseling and support, and medication.

Sources: Cardiomyopathy,  Johns Hopkins Medicine; Broken Heart Syndrome,  Johns Hopkins Medicine; Is Broken Heart Syndrome Real?,  American Heart Association, 2024; About Heart Disease and Mental Health,  Centers for Disease Control and Prevention, 2024; How to Prevent Heart Disease,  U.S. National Library of Medicine, 2024; Is broken heart syndrome becoming more common?,  Harvard Medical School, 2022; Stress and Heart Health,  American Heart Association, 2024 

Originally published 2/23/2015: Revised 2020, Reviewed 2022, 2024