After the actress Debbie Reynolds died on Wednesday at age 84, one day after the death of her daughter, Carrie Fisher, her son Todd Fisher reported that Reynolds had succumbed to a stroke. She’d been at her son’s home, in the midst of making funeral plans for Carrie. Though Reynolds’ health had been somewhat fragile over the past year, it was hard not to imagine that the grief from losing her daughter had been physically overwhelming. Theories that Reynolds had died of a “broken heart” soon began flying around online. And broken heart syndrome, or “takotsubo cardiomyopathy,” as it’s formally known, actually does exist.
The takotsubo comes from the observation that during this condition, the shape of the heart tends to change enough during its pumping to resemble a Japanese octopus trap (called a tako-tsubo). Takotsubo, discovered in Japan in 1990, is rare. It’s also rarely fatal. The prognosis is generally favorable.
In fact, when takotsubo is diagnosed, it tends to yield a sigh of relief from physicians. That’s because the condition often closely mimics a much more serious condition, a heart attack (myocardial infarction). Takotsubo cardiomyopathy is usually far more benign. Here’s how it tends to play out: A patient presents to an emergency department with chest pain. Typically, the patient is a postmenopausal woman who has recently experienced a significant emotional stress. Though Reynolds fits this profile, needless to say, it’s important to resist diagnosing her from afar. But in the case of broken heart syndrome, the electrocardiogram exhibits fairly horrifying features, suggesting a heart attack (i.e., a coronary artery that is so blocked that the heart muscle near it has died). The patient is then rushed to a cardiac catheter facility, where an interventional cardiologist introduces a needle and a small camera (usually via the blood vessels in the wrist or inner thigh), which is advanced all the way to the heart. Dye is injected, and if there are any blockages in the coronary arteries, they are identified and often stented open.
During a heart attack, time is of the essence. The sooner that blocked coronary vessel is opened, the less heart muscle will die. But in the case of takotsubo, the arteries aren’t blocked at all. The cardiologist is usually surprised, and pleased, to find the coronary arteries to be wide open. However, an ultrasound of the heart will subsequently show that this heart has, for some reason, suddenly lost its ability to pump out blood at maximal efficiency. This is called acute heart failure. (The differences between a heart attack, heart failure, and cardiac arrest are described in a piece I wrote on Wednesday.) Part of the heart, the left ventricle, also “balloons out,” giving it the octopus trap–like appearance. Unlike many forms of heart failure, takotsubo is usually reversible. Over a few weeks, the heart tends to return to its normal function.
The molecular mechanism for takotsubo remains a source of debate among specialists. But stress hormones causing strain to the heart, whether due to overpowering emotions, drugs, or some other underlying medical problem, do seem to be the most likely culprit. So while “broken heart syndrome” does not mean a patient’s heart is permanently broken, it’s painful—and very much real.