New research has found that “broken heart syndrome”—formally known as takotsubo cardiomyopathy (TC)—carries a significant risk of mortality and serious complications, particularly for men.
Despite being more commonly diagnosed in women—who comprised approximately 80% of cases in the study—men were found to be more than twice as likely to die from the condition. The study, published May 14 in the Journal of the American Heart Association, raises pressing questions about sex-based differences in outcomes and highlights a need for improved treatment strategies.
Takotsubo cardiomyopathy is a temporary cardiac condition often triggered by intense emotional or physical stress, such as the death of a loved one or a traumatic accident. The condition leads to a sudden weakening and ballooning of the heart’s left ventricle, impairing its ability to pump blood efficiently.
Read More: Maria Grazia Chiuri to Depart Dior After Nine Years
While the syndrome has long been associated with major complications—including heart failure, atrial fibrillation, stroke, and cardiogenic shock—the new findings suggest that men who develop TC are at especially high risk of poor outcomes. The reason for this disparity remains unclear.
“We were surprised to find that the death rate from takotsubo cardiomyopathy remained relatively high over the five-year study period, without significant improvement, despite advancements in cardiovascular care,” said lead author Mohammad Reza Movahed, MD, PhD, an interventional cardiologist and clinical professor of medicine at the University of Arizona’s Sarver Heart Center. “The continued high mortality rate is alarming and underscores the need for further research and the development of targeted therapies.”
Experts unaffiliated with the study echoed the call for further investigation. “It’s definitely hypothesis-generating,” said Dr. Abha Khandelwal, a cardiologist and associate professor of medicine at Stanford Medicine. “We still have much to learn about which patients are most at risk of developing the more dangerous forms of this condition.”
As awareness of takotsubo cardiomyopathy grows, researchers hope these findings will prompt a closer look at how gender influences outcomes—and how treatment can be tailored to reduce the risk of fatal complications.
A ‘Woman’s Disease’ That’s Far Deadlier for Men
Although takotsubo cardiomyopathy (TC) is overwhelmingly diagnosed in women, new research suggests that when men develop the condition, they face a significantly higher risk of death.
The study, which analyzed data from the Nationwide Inpatient Sample (NIS)—a large, publicly available database of de-identified hospital records—identified nearly 200,000 cases of TC between 2016 and 2020. Consistent with previous research, women accounted for the vast majority of cases (83%), and the average age of patients was 67.
Strikingly, while men made up a much smaller proportion of those diagnosed, their mortality rate was more than double that of women: 11.2% compared to 5.5%.
Researchers were unable to pinpoint the causes of this disparity, as the study was observational in nature and could only establish associations, not causation. However, demographic patterns were also apparent in the findings—approximately 80% of patients were white—raising questions about racial differences in either prevalence or diagnosis.
Dr. Abha Khandelwal, a cardiologist and associate professor at Stanford Medicine, who was not involved in the study, believes the gender-based discrepancy in outcomes may partly stem from how TC is perceived and recognized.
“Takotsubo has long been thought of as a ‘woman’s disease,’ and when a condition presents in a way we expect, outcomes tend to be better,” she said. “But when it occurs in patients who fall outside that pattern—like men in this case—the risk of misdiagnosis or delayed treatment increases. It’s reminiscent of how heart disease was once viewed as a ‘man’s disease,’ to the detriment of women who weren’t treated appropriately.”
The study also found that many patients with TC had concurrent cardiovascular complications. The most common included:
- Congestive heart failure (36%)
- Atrial fibrillation (21%)
- Cardiogenic shock (7%)
- Stroke (5%)
Overall, patients hospitalized with TC were nearly three times more likely to die compared to those hospitalized for other reasons (6.58% vs. 2.41%).
Despite its severity in some cases, takotsubo cardiomyopathy is typically a reversible condition, with most patients recovering fully within two months. Recurrence is rare.
Still, the persistently high mortality rate observed in the study remains difficult to fully explain. Dr. Khandelwal cautioned that the data lacked important clinical details that might influence outcomes.
“This study tells us which patients were hospitalized with TC, but not much about their individual clinical presentations,” she said. “Many were critically ill, and their outcomes could have been shaped by other underlying conditions. Without more granular data, we can’t say for certain what’s driving the elevated risk.”
The authors of the study also noted that the rising prevalence of TC diagnoses may reflect increased clinical awareness, suggesting that in years past, similar cases might have been misclassified as other forms of acute coronary syndrome.
What Triggers a ‘Broken Heart’?
Takotsubo cardiomyopathy (TC), often referred to as “broken heart syndrome,” remains a medical mystery in many respects—but its emotional associations are well earned.
The condition is typically triggered by intense emotional or physical stress, such as the sudden loss of a loved one, a traumatic event, or even an unexpected fright. Dr. Abha Khandelwal, a cardiologist at Stanford Medicine, recalls treating a patient who developed TC after being startled by her young grandchild—a testament to how seemingly benign moments can provoke profound physiological responses.
While rare, TC accounts for an estimated 2–3% of patients presenting with symptoms of acute coronary syndrome, with the rate rising to 5–6% among women. However, these figures may underestimate its true prevalence due to underdiagnosis and symptom overlap with other cardiac conditions.
Clinically, TC often mimics a heart attack. Common symptoms include:
- Sudden chest pain
- Shortness of breath
- Dizziness
- Cold sweats
- Heart palpitations
Diagnosis requires ruling out coronary artery blockages, typically via an angiogram, followed by imaging such as an echocardiogram to identify characteristic abnormalities in the heart’s left ventricle.
Though grief is a well-known trigger, TC can also follow physical stressors such as car accidents, surgeries, or acute illnesses. This broader understanding has led to the alternate term “stress-induced cardiomyopathy.”
Despite ongoing research, the precise mechanisms behind TC are not fully understood. The leading hypothesis involves a surge of catecholamines—stress hormones like norepinephrine and epinephrine—that temporarily “stun” the heart, impairing its ability to contract effectively. This hormonal flood is believed to disproportionately affect the left ventricle, causing the hallmark ballooning seen in imaging.
Adding to its complexity, TC sometimes arises without any clear trigger, leaving researchers puzzled. Its unpredictable onset and rarity make both prevention and early detection challenging.
“We still can’t predict who is going to get it, or under what circumstances,” said Khandelwal. “Is there a stress threshold? We don’t know. And even among those who do develop it, we can’t yet identify who is at risk for the more dangerous, malignant forms.”
This uncertainty underscores the need for greater awareness, earlier diagnosis, and deeper investigation into the biological and psychological interplay at the heart of this enigmatic condition.
Frequently Asked Questions
What is ‘Broken Heart Syndrome’?
‘Broken Heart Syndrome,’ medically known as takotsubo cardiomyopathy (TC), is a temporary heart condition triggered by severe emotional or physical stress. It causes sudden weakening of the heart’s left ventricle, leading to symptoms similar to a heart attack.
Why is it called ‘Broken Heart Syndrome’?
The name comes from the condition’s association with intense emotional stress, such as grief or trauma, which can physically “stun” the heart and impair its function.
Who is affected by ‘Broken Heart Syndrome’?
While TC predominantly affects women—about 80% of cases occur in females—men who develop the condition face a higher risk of serious complications and death.
How much more likely are men to die from this condition compared to women?
According to recent research, men are more than twice as likely to die from ‘Broken Heart Syndrome’ compared to women (11.2% vs. 5.5% mortality rate).
What symptoms should I watch for?
Common symptoms include sudden chest pain, shortness of breath, dizziness, cold sweats, and heart palpitations. These symptoms often mimic a heart attack.
How is ‘Broken Heart Syndrome’ diagnosed?
Diagnosis involves ruling out coronary artery blockages through angiograms and identifying characteristic heart muscle abnormalities using imaging techniques like echocardiograms.
Conclusion
While takotsubo cardiomyopathy—or “broken heart syndrome”—has long been viewed as a condition that primarily affects women, emerging research reveals a far more complex and concerning reality: men, though less frequently diagnosed, are significantly more likely to die from it. This paradox highlights critical gaps in our understanding of the condition, including why outcomes vary so dramatically by sex and what factors may contribute to these differences.
The findings underscore the urgent need for increased awareness, earlier diagnosis, and more targeted treatment strategies—especially for male patients who may not fit the conventional profile.