'Broken heart syndrome' can look remarkably similar to a heart attack, making it difficult for doctors to distinguish between the two when a patient first arrives at hospital.

Also known as Takotsubo syndrome or stress cardiomyopathy, the condition can cause sudden chest pain and shortness of breath. An electrocardiogram (ECG) can also show changes resembling those seen during a heart attack.

New research from the University of Zurich has identified a potential way to help doctors make the distinction without immediately resorting to invasive testing.

What Is Broken Heart Syndrome?

Takotsubo syndrome is a temporary weakening of the heart muscle that can occur after intense emotional or physical stress. The heart's main pumping chamber changes shape and does not contract normally, which can temporarily reduce its ability to pump blood.

The condition has earned the nickname 'broken heart syndrome' because it can occur after major emotional events such as bereavement, although physical stress can also trigger it.

Importantly, the symptoms can be virtually indistinguishable from those of a heart attack.

Why Can It Be Confused With a Heart Attack?

A heart attack usually occurs when a blood clot blocks blood flow through one of the coronary arteries supplying the heart. The resulting lack of oxygen can damage the heart muscle.

Takotsubo syndrome does not usually involve the same type of blocked coronary artery. However, both conditions can produce chest pain, breathlessness, ECG abnormalities and elevated levels of troponin, a protein released when heart muscle is damaged.

That overlap means doctors cannot simply rely on symptoms or a single blood test to tell them apart.

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How Do Doctors Tell The Difference?

When a heart attack is suspected, doctors typically perform an ECG and blood tests, including measurements of troponin. If the results suggest a heart attack, further investigations may include an echocardiogram and coronary angiogram.

A coronary angiogram allows doctors to see whether there is a blockage in the arteries supplying the heart. In Takotsubo syndrome, the coronary arteries generally do not show a blockage that explains the heart's abnormal movement.

An echocardiogram can also reveal characteristic changes in how the heart muscle contracts, helping clinicians identify the pattern associated with Takotsubo syndrome. Cardiac MRI may provide additional information when the diagnosis remains uncertain.

What Did The New Study Find?

Researchers have developed the BioTAK score, which combines five biological factors to estimate whether a patient is more likely to have Takotsubo syndrome rather than a heart attack.

The study, published in the European Heart Journal, analysed data from 3,615 patients across two overlapping registries. Researchers reported that the score could classify almost 90% of patients into a likely diagnosis before invasive coronary angiography.

The potential benefit is significant: if validated in further research, a reliable early assessment could help doctors identify patients who are likely to have Takotsubo syndrome and potentially reduce the need for some invasive investigations.

However, the new score is not a replacement for emergency assessment. More research is needed before determining how it should be incorporated into routine clinical practice.

When Should You Seek Emergency Help?

Because Takotsubo syndrome and heart attacks can produce similar symptoms, people should not try to determine the cause themselves.

Sudden chest pain, pressure or heaviness, severe breathlessness, sweating, nausea, dizziness, or pain spreading to the arm, jaw, neck, or back can be signs of a heart attack and require urgent medical attention.

Even if emotional stress appears to be the trigger, symptoms should not automatically be attributed to 'broken heart syndrome'. Doctors need to rule out a potentially life-threatening heart attack first.

Frequently Asked Questions

  • What is Broken Heart Syndrome?
    Broken Heart Syndrome, also known as Takotsubo syndrome, is a temporary weakening of the heart muscle that can occur after intense emotional or physical stress.
  • How can Broken Heart Syndrome be distinguished from a heart attack?
    Doctors use a combination of ECG, blood tests, echocardiograms, and coronary angiograms to differentiate between Broken Heart Syndrome and a heart attack.
  • What is the BioTAK score?
    The BioTAK score is a tool developed to estimate whether a patient is more likely to have Takotsubo syndrome rather than a heart attack, using five biological markers.
  • When should you seek emergency help for chest pain?
    Seek emergency help if you experience sudden chest pain, pressure, severe breathlessness, sweating, nausea, dizziness, or pain spreading to the arm, jaw, neck, or back.
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