Sudden Stress Breaks Hearts, a Report Says

Sudden emotional stress - from grief, fear, anger or shock - can cause heart failure, in a little known and poorly understood syndrome that seems to affect primarily women, researchers are reporting today. The victims are generally healthy, with no history of heart disease.

A death in the family, an armed robbery, a car accident, a biopsy procedure and a surprise party were among the events that sent 18 women and one man to coronary care units in Baltimore with chest pains and weakening of the heart, according to an article in The New England Journal of Medicine.

Most were older: their median age was 63. But one was 27, another 32. Some had such poor heart function that they would have died without aggressive treatment to keep their blood circulating, the researchers said. But all recovered.

The cases were described by doctors from Johns Hopkins University who treated the patients from 1999 to 2003.

The new research on the condition, nicknamed broken heart syndrome by the doctors, suggests there may be some truth to the old idea that people can be scared to death or die from sorrow like characters in a romantic novel or a country song.

"It's important for people to know that this is something that emotional stress truly can do," said Dr. Ilan S. Wittstein, a cardiologist at Johns Hopkins University School of Medicine and the lead author of the article.

"How exactly it occurs is not clear, but the patients had unusually high levels of stress-related brain chemicals and hormones like adrenaline, which may have temporarily impaired their heart function. Why nearly all the victims were female is also unknown.

The researchers' scientific name for the condition is stress cardiomyopathy. It is not a heart attack, though it may be mistaken for one. The patients recovered fully and, unlike heart attack victims, did not suffer lasting damage to the heart muscle.

The researchers say it is important to distinguish the syndrome from a heart attack so that people can be treated properly and reassured that their hearts are healthy, rather than being told they have coronary disease and need to be on heart medicine for the rest of their lives. A mistaken diagnosis of heart attack may also make it harder for a person to get life or health insurance.

Heart attacks occur when a blood clot in a coronary artery cuts off circulation to the heart muscle, which may then die. Emotional stress can bring on a heart attack in someone who has coronary disease.

But with stress-induced heart failure, patients do not have blood clots, diseased arteries or patches of dead heart muscle. They have a weakening of the heart that decreases its ability to pump, but it is temporary.

"The prognosis seems to be excellent," Dr. Wittstein said. "It is incredibly important not to be sent out thinking you've had a massive heart attack. Doctors and patients should both know that."

How often the condition occurs is not known. But the severity seems to range from mild to deadly. Some people may feel a bit ill for a short time and never see a doctor, but others may die if not treated, he said.

"The only thing making it not a common problem is the inability to recognize it," Dr. Wittstein said, adding that he expected the number of cases to rise as word got out and doctors learned how to diagnose the syndrome. When he gives talks about it at conferences, doctors often approach him later and say, "You know, I think I saw a case like that," he said.

But some cardiologists remain skeptical about the condition, he said.

"Will it turn out to be as common as a conventional heart attack?" Dr. Wittstein asked. "Of course not."

He said he and his colleagues saw about half a dozen cases a year. "But they seem to come in waves," he said. "We had three in the past 10 days."

One of the earlier patients, he said, was a 60-year-old woman whose family had given a surprise birthday party for her.

"Seventy people jumped out from the dark and screamed, 'Surprise!' and literally three hours later she was in the intensive care unit," Dr. Wittstein said.