February 10, 2005
Severe Emotional Stress Can Release Chemicals That Mimic Heart Attack

Catecholamines released in response to sudden emotional stress can cause life-threatening heart failure called stress cardiomyopathy that can be misdiagnosed as a conventional heart attack.

Now, researchers at Johns Hopkins have discovered that sudden emotional stress can also result in severe but reversible heart muscle weakness that mimics a classic heart attack. Patients with this condition, called stress cardiomyopathy but known colloquially as "broken heart" syndrome, are often misdiagnosed with a massive heart attack when, indeed, they have suffered from a days-long surge in adrenalin (epinephrine) and other stress hormones that temporarily "stun" the heart.

"Our study should help physicians distinguish between stress cardiomyopathy and heart attacks," says study lead author and cardiologist Ilan Wittstein, M.D., an assistant professor at The Johns Hopkins University School of Medicine and its Heart Institute. "And it should also reassure patients that they have not had permanent heart damage."

In the Hopkins study, to be published in The New England Journal of Medicine online Feb. 10, the research team found that some people may respond to sudden, overwhelming emotional stress by releasing large amounts of catecholamines (notably adrenalin and noradrenalin, also called epinephrine and norepinephrine) into the blood stream, along with their breakdown products and small proteins produced by an excited nervous system. These chemicals can be temporarily toxic to the heart, effectively stunning the muscle and producing symptoms similar to a typical heart attack, including chest pain, fluid in the lungs, shortness of breath and heart failure.

Upon closer examination, though, the researchers determined that cases of stress cardiomyopathy were clinically very different from a typical heart attack.

"After observing several cases of 'broken heart' syndrome at Hopkins hospitals - most of them in middle-aged or elderly women - we realized that these patients had clinical features quite different from typical cases of heart attack, and that something very different was happening," says Wittstein. "These cases were, initially, difficult to explain because most of the patients were previously healthy and had few risk factors for heart disease."

For example, examination by angiogram showed no blockages in the arteries supplying the heart. Blood tests also failed to reveal some typical signs of a heart attack, such as highly elevated levels of cardiac enzymes that are released into the blood stream from damaged heart muscle. Magnetic resonance imaging (MRI) scans confirmed that none of the stressed patients had suffered irreversible muscle damage. Of greatest surprise, the team says, was that recovery rates were much faster than typically seen after a heart attack. Stressed patients showed dramatic improvement in their hearts' ability to pump within a few days and had complete recovery within two weeks. In contrast, partial recovery after a heart attack can take weeks or months and, frequently, the heart muscle damage is permanent.

The researchers collected detailed histories and conducted several tests, including blood work, echocardiograms, electrocardiograms, coronary angiograms, MRI scans and heart biopsies, on a total of 19 patients who came to Hopkins between November 1999 and September 2003. All had signs of an apparent heart attack immediately after some kind of sudden emotional stress, including news of a death, shock from a surprise party, fear of public speaking, armed robbery, a court appearance and a car accident. Eighteen of the stressed patients were female, between the age of 27 and 87, with a median age of 63. The results were then compared to seven other patients, all of whom had suffered classic, severe cases of heart attack, called a Killip class III myocardial infarction.

When results from both groups were compared, the researchers found that initial levels of catecholamines in the stress cardiomyopathy patients were two to three times the levels among patients with classic heart attack, and seven to 34 times normal levels.

Catecholamine metabolites, such as metanephrine and normetanephrine, were also massively elevated, as were other stress-related proteins, such as neuropeptide Y, brain natriuretic peptide and serotonin. These results provided added confirmation that the syndrome was stress induced. Heart biopsies also showed an injury pattern consistent with a high catecholamine state and not heart attack.

Note that 18 out of the 19 patients diagnosed with stress cardiomyopathy were women. Do men suppress their emotional responses and thereby lower their risk of stress cardiomyopathy?

I predict that some day people will have embedded drug dispensers in their bodies that have integrated sensors that will be able to detect the chemicals released by a severe emotional stress episode. The sensor devices embedded in a body will have integrated drug dispensers that together will act like an extension of the endocrine system. The artificial endocrine organs will be able to react to the severe stress reaction by releasing compounds that will damp down the stress response to put the stress response back within a safe range by neutralizing the catecholamines and other compounds released in response to severe emotional stress.

Severe emotional stress is bad for your health. To the extent that it is practically possible structure your life to avoid circumstances and events that will elicit intense emotional feelings of stress.

Share |      Randall Parker, 2005 February 10 01:15 AM  Brain Emotions

David Nishimura said at February 10, 2005 3:57 PM:

Implanted dispensers are all well and good, but I would think we'd be able to come up much sooner with something to be taken orally or by self-administered injection. Not much help for surprise party victims, perhaps, but something to carry around for recent widows and widowers above a certain age.

Tj Green said at February 11, 2005 3:31 PM:

Going to work with a viral infection(apart from spreading and therefore creating endless viral mutations) can also damage the heart.

Ida Rowlands said at February 18, 2005 9:53 PM:

Is it possible that severe stress can also induce stroke in some patients? Please email me at ida.rowlands@sympatico.ca if you know where I can do research on this. Thank you.

Rachel Basaca said at March 24, 2005 9:41 AM:

I truly believe that this is what I just experienced this last friday, I was diagnosed as having had a heart attack. The night prior to having it. I had had severe emotional distress and a major blow up with my husband.

Mary L. sfasciotti said at April 4, 2005 5:33 PM:

My elderly mother suffers from panic attacks that some doctors have thought were ministrokes. Is there a difference between a symptom that is a mini stroke and a serious panic attack?

Mary L. sfasciotti said at April 4, 2005 5:33 PM:

My elderly mother suffers from panic attacks that some doctors have thought were ministrokes. Is there a difference between a symptom that is a mini stroke and a serious panic attack?

sharon said at May 5, 2005 7:10 PM:

I am going through a messy divorse. I am suffering from severe emostional destress. My husband and his girl friend are constantly following and harrassing me. I've been to court several times with no solution. My son hates his father and hates his girlfriend. I caught them in bed together. He had been cheating on me for a long time with her. He broke my heart and my son's heart. the things he has done to both of us have left permant scars on us

donna said at August 2, 2005 8:49 PM:

Two years ago, my best friend committed suicide. I was diagnosed as having a heart attack when I heard about it. Enzyme rate was low and I spent one night at the hospital. Two weeks ago, my husband was in a near fatal car accident and I again experienced typical symptoms for heart attack, but lab work showed only slight elevation of cardiac enzymes, a small blockage in a secondary artery, no heart muscle damage; however, I spent three days in the hospital because my doctor wanted to treat it as a a "real" heart attack. After the heart cath, he admitted that my case was baffling but he attributed the symptoms to a flood of adrinaline. He put me on Toprol XL which I hate because of the side effects and also on Plavix, a higher dose of a statin and Diovan, as well as Imdur, a vasodialator, and aspirin. After reading your article,I am thinking that I am experiencing the problem you describe. I plan to share this with my cardiologist because I think I am over- medicated for a condition that I really don't have. Your advise to keep our lives as stress free as possible is correct, but improbable. Most likely I should join a Yoga class and drop the meds. I am 59 and just retired from teaching,so I am available to care for my husband who will be disabled for many months. I am a little afraid that managing stress effectively enough to prevent another "attack" is something that I need to learn how to do. Just how much control can I have over this condition? Am I correct in thinking that I have too many unneccesary meds?

Sam said at December 2, 2005 8:46 PM:

I believe I've experienced what's described in this paper.

I often debate people on internet forums about politics, sometimes the debates will last days and can be very emotional. I often experience pains in my chest near my heart during these debates - like angina, my heart rate will race at certain times during a debate, sometimes the debate will drive me into tears (severe emotional stress).

I'm only 25 (male). I recently had one of these debates, during which I experienced occassional piercing pains in my chest, at my heart - it's been a week since the debate - they aren't all that bad now, just annoying - occassional slight pains.

During periods in my life where I'm not debating on the internet and getting exercise, I never experience the pains.

I'm glad I found this study.

Thank you,


Amy said at December 8, 2005 8:55 AM:

I have been experincing, these symptoms. I lose my eye sight in my left eye and I slump to the left have trouble walking when this is accuring. I have had 3 of these that has happened. I just had a MRI, and a EEG done plus many blood draws. I also have high pulse rates most of the time they are at least 125, The worst I have had was 142. I use to be a med aide so I am very familure with taking vitals. The Neuroligst I have seen told me that she thinks it is due to stress. She did make an appt with a heart doctor. To do a ultrasound on my neck to check the arteriies in my neck. I am 38 yrs old female. I feel like no one is listening to me, I know something is not right but what do you do. I live in a rural area in Nebraska, not alot of specilists around or trust. Thankyou for alowing me to tell my story. Amy

Lori said at December 10, 2005 8:44 AM:

Is it possible for someone as young as me to suffer from this? (Age, 19)

mike said at February 5, 2006 10:48 AM:

I think I've experienced what's described in this paper. Although I'm only 19 (male). I've had a lot of problems emotionally, and when these problems arise I will get a pain in my heart (literal, physical pain), a little sharp. For a week or two after these experiences, moving around I can feel my heart is soar; still hurts a little during forms of excitation (i.e., exercise, or anything else that gets its beat up). I think my judgement is also affected when I have these experiences. as a side note also I'm prone to depressive attitutes and frequently am the pessimist.

Broken Hearted said at July 15, 2007 9:31 PM:

I too am sure I have suffered the same. I am a 34 yr old male.I found out my wife has been talking to an ex-boyfriend over the Internet. I was enraged with anger which triggered spells of dizziness and almost passing out when trying to walk. My heart would race and it was not an emotional psychosomatic event. It knocked me off of my feet, I was unable to get out of bed, I had Mild chest pain and pain in my arm. I thought I had a heart attack and feared going to the hospital. After reading articles simaler to this one I realized I must keep my stress levels and feelings of anger at bay, In 3 days I am almost feeling back to normal. I can now walk about without nearly passing out. Tomorrow I am going to see a doctor.

anthony said at September 26, 2007 2:56 PM:

Hello I have been having acute anxity attacks after sexually intercourse. I have had alot of the symtoms decribe above. Before all this started I was under tremendous stress and anger dealing with personal family matters. Only after dealing with these stressful situation has my body gone crazy on me. Do you think, after being under tremendous stress, that sexually intercouse set these symtoms in Motion?

Eby said at February 10, 2009 10:06 AM:

I am 53 years old, female, and have a history of just what you are describing. I have been to the doctor, had ekgs, blood work - even a stress test years ago, and nothing has pointed to a heart attack. I was diagnosed with acid reflux and all the symptoms were attributed to that- even though they included chest pain, weakness, pain radiating down the arm and on the left side of my face. I have said that it takes me a couple of days to recover from these episodes. I have had a life of great stress -a marriage that for most of 30 years, included bouts of rage from my husband, sometimes including physical abuse. For a time, I experienced what I now believe were panic attacks. I left for 2 years and we are together again, because he is a greatly changed man. Recently though, I was in a musical and on the day of the first performance, I cried to God for mercy to get me through it - probably the large amounts of adrenalin that coursed through my body as they once did in the frequent times of 'fight or flight' reaction?? I was scared and puzzled- I hope this is the answer I'm looking for. I know exactly how "Amy" feels when she thinks no one is listening and she doesn't know what to do. This research provides some hope. Thanks.

Judy said at October 4, 2010 10:31 AM:

I just recently suffered a "heart attack" called Broken Heart Syndrome just like this article. I am a 57 year old healthy female,I had the cardiac cath done and no blockages. My echo showed a changed shape in my heart which is classic for this syndrome. But I had elevated blood pressure, elevated cardiac enzymes and classic symptoms of a heart attack. It has only been 2 weeks since this occurred so I have not had a repeat Ecg or echo cardiogram so I don't know yet if any improvements. I don't know exactly what event would have brought this on. About 6 days before this happened I had a endometrial biopsy that really hurt and stressed me out but that was days not hours before this attack. It appears to still be somewhat a mystery about this Broken Heart Syndrome.

Anonymous said at October 20, 2010 8:19 AM:

Two years ago I woke up at about 3:00am because of difficulty breathing. Since I suffer from COPD, I assumed my lungs were shutting down. 911 was called and I was taken to the hospital.I was totally flabbergasted when a heart doctor came into the room and told me it was my heart, not my lungs. I had suffered a heart attack but there was no blockages. He said it was called Broken Heart Syndrome. My meds for treating it ever since is Coreg and Enalapril. Both are blood pressure medications. One gets the blood to your heart faster and the other suppresses your adrenal gland.
I am a female and was 63 when the episode happened. Hope this helps some one.

Ronald said at November 4, 2011 3:34 PM:

My wife filed for a divorce after we came back from our 27th anniversary vacation. I won't get into the particulars but I have been feeling very alone. She left me and then my daughter and grand kids left because I was going to sell or property. Anyway, I have been very hurt. Last week I went to the E.R. with severe chest pains. They did an EKg and took xrays but found .nothing wrong with my heart. About 30 minutes ago I texted my soon to be ex-wife and asked if she could stop by because I am feeling very alone and I am starting to get those chest pains again. Do I go to the E.R. every time I get those pains just to be sure. My wife left me because she said she has fallen out of love for me. That's a broken heart.

Christi Chubbuck said at November 29, 2011 2:21 PM:

Ronald - I feel your pain. Recently I was told by my significant other that we need to go our separate ways. Maybe I was a fool for falling in love with someone that was married. Maybe I should've known this extremely charming individual would nevertheless return home to the spouse. What was I thinking? But I fell in love like a teenage fool and now I've hit rock bottom. And if it were not for my chest pains, I wouldn't even have stumbled on this site & article. At least we can take solace in the fact that it's not a real heart-attack.., it doesn't break down our heart tissue.

acumagnet said at February 13, 2012 9:59 AM:

I suffer severe loneliness and abandonement issues that i feel directly at my heart during times of increased stress.

Sangay said at April 7, 2012 5:14 AM:

I am just 21. As u have described above, i feel i am also suffering from this disease. I easily get emotional over small things. I have boyfriend and sometimes when he doesnt call me or when he dont talk with me nicely when i call, i feel a sharp pain over my heart. And the next thing that i do is cry. I think i have a very weak heart. I cant control my emotions. Is there any chance that i will get heart disease?

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